Showing papers in "Obstetrical & Gynecological Survey in 1986"
TL;DR: HLA-B genotype data in families containing multiple members affected with nonclassical 21-hydroxylase deficiency is used together with the results of quantitative hormonal tests to arrive at estimates of gene and disease frequencies for this disorder.
Abstract: Nonclassical steroid 21-hydroxylase deficiency is an autosomal recessive disorder that is defined by clinical and hormonal criteria that distinguishes it from the classical 21-hydroxylase deficiency. No estimates of the gene frequency of nonclassical 21-hydroxylase deficiency, also called attenuated, late-onset, acquired, and cryptic adrenal hyperplasia, have been published thus far. Here, we have used HLA-B genotype data in families containing multiple members affected with nonclassical 21-hydroxylase deficiency together with the results of quantitative hormonal tests to arrive at estimates of gene and disease frequencies for this disorder. We found nonclassical 21-hydroxylase deficiency to be a far more common disorder than classical 21-hydroxylase deficiency, which occurs in 1/8,000 births. The prevalence of the disease in Ashkenazi Jews was 3.7%; in Hispanics, 1.9%; in Yugoslavs, 1.6%; in Italians, 0.3%; and in the diverse Caucasian population, 0.1%. The gene for nonclassical 21-hydroxylase deficiency is in genetic linkage disequilibrium with HLA-B14 in Ashkenazi Jews, Hispanics, and Italians, but not in Yugoslavs or in a diverse, non-Jewish, Caucasian group. The penetrance of nonclassical 21-hydroxylase deficiency gene in the HLA-B14 containing haplotypes was incomplete. Thus, nonclassical 21-hydroxylase deficiency is probably the most frequent autosomal recessive genetic disorder in man and is especially frequent in Ashkenazi Jews, Hispanics, Italians, and Yugoslavs.
495 citations
TL;DR: The findings in this study provide a rationale for classifying noninvasive endometrial proliferations primarily on the basis of cytologic atypia since this is the most useful criterion in predicting the likelihood of progression to carcinoma.
Abstract: Endometrial curettings from 170 patients with all grades of endometrial hyperplasia, who did not undergo a hysterectomy for at least 1 year were evaluated in order to correlate the histopathologic features with behavior. Follow-up ranged from 1 to 26.7 years (mean, 13.4 years). Cytologic and architectural alterations were analyzed separately in order to assess their respective roles in predicting the likelihood of progression to carcinoma. Classification of proliferative lesions based solely on the presence of cytologic atypia revealed that atypia was a discriminant factor. Proliferations lacking cytologic atypia were designated hyperplasia and those displaying atypia were designated atypical hyperplasia. Only 2 (1.6%) of 122 patients with hyperplasia progressed to carcinoma compared with 11 (23%) of women with atypical hyperplasia (P = 0.001). Subclassification of the two forms of hyperplasia (those with cytologic atypia and those without) was performed using the degree of architectural abnormalities. Hyperplasia and atypical hyperplasia displaying marked glandular complexity and crowding producing a back-to-back appearance were designated complex hyperplasia (CH) and complex atypical hyperplasia (CAH), respectively. Hyperplasia and atypical hyperplasia with lesser degrees of glandular complexity and crowding were designated simple hyperplasia (SH) and simple atypical hyperplasia (SAH), respectively. Progression to carcinoma occurred in 1 (1%) of 93 patients with SH, in 1 (3%) of 29 patients with CH, in 1 (8%) of the patients with SAH, and in 10 (29%) of the patients with CAH. The differences between the four subgroups suggest a trend but are not statistically significant. The findings in this study provide a rationale for classifying noninvasive endometrial proliferations primarily on the basis of cytologic atypia since this is the most useful criterion in predicting the likelihood of progression to carcinoma. In addition, the presence of concommitant architectural alterations appears to identify a particularly high-risk subgroup.
371 citations
341 citations
TL;DR: For example, a healthy woman bearing a normal sized fetus, with an average birth weight of about 3.3 kg, will increase her plasma volume by about 1250 ml, a little under 50% of the average non-pregnant volume for white European women of about 2600 ml as discussed by the authors.
Abstract: The plasma volume and total red cell mass are controlled by different mechanisms and pregnancy provides the most dramatic example of the way in which that can happen. A healthy woman bearing a normal sized fetus, with an average birth weight of about 3.3 kg, will increase her plasma volume by an average of about 1250 ml, a little under 50% of the average non-pregnant volume for white European women of about 2600 ml. There is little increase during the first trimester, followed by a progressive rise to a maximum at about 34-36 weeks, after which little or no further increase occurs. It seems certain that the frequently observed fall in plasma volume in the last six weeks of pregnancy is an artefact of measurement due to poor mixing of tracer when the woman lies supine and obstructs the circulation to her lower limbs. The maximum increase depends largely on the size of the conceptus. It is somewhat increased, perhaps to a mean of 1300 ml, in association with the bigger baby of multiparae and increases still more with twins, triplets and quadruplets. Red cell mass increases by relatively much less, a rise of about 250 ml (some 18% of the non-pregnant volume) in women who take no supplemental iron, and between 400 and 450 ml when iron supplements are taken. The rise is probably linear from the end of the first trimester to term, and there is some evidence of a preliminary fall in red cell mass during the first trimester. As a result of the relatively much greater increase in plasma volume, red cells in the blood are 'diluted' and the venous haematocrit drops from a non-pregnant average of about 40 to about 33 during the last trimester. The differential changes are biologically plausible: red cell mass rises proportionately to the need to carry the extra oxygen taken up in pregnancy; the greater plasma volume increment is needed to cope with the very large increases in blood flow to organs which require little extra oxygen, the skin and the kidneys.
311 citations
TL;DR: Overall, the literature supports the finding that women and their offspring experience significant increased problems as maternal age progresses through the mid-30s and beyond.
Abstract: We are in the early phase of a period when the increased numbers of women born during the 1947 to 1965 baby boom are entering their later child-bearing years. They are also part of a generation of women who are increasingly delaying childbirth until their 30s. These two factors will likely increase the proportion of total births accounted for by this 35- to 49-year age group by 72 per cent, from 5.9 per cent in 1982 to 8.6 per cent by the turn of the century. There are important and specific risks related to pregnancies for older women as compared to younger women. It is likely that a woman's ability to conceive declines steadily to where it has been estimated that 34 to 46 per cent of women age 35 and older are unable to become pregnant. Hypertension, preeclampsia, and diabetes mellitus are not only more common but seem to carry an even greater risk for older women, resulting more frequently in fetal demise. Although there are conflicting findings, older women seem to have more babies weighing under 2,500 gm and more over 4,000 gm. It appears that there are more problems with abnormal labor patterns and a definite higher incidence of cesarean section. The literature seems to support the finding of high incidences of late pregnancy bleeding from placenta previa and abruptio placenta. Many of those factors contribute to a several-fold increase in maternal mortality for older compared to younger pregnant women. The fetus, likewise, is at greater risk. There appears to be a greater risk for spontaneous abortion, although the magnitude of the risk is unclear because of the potential confounding from gravidity, birth order, and reduced fecundity. The stillbirth rate seems to double by the late 30s and increases to 3- to 4-fold by the mid-40s. The neonatal mortality rate seems to have a mild association with maternal age. Chromosome abnormalities, especially trisomies 13, 18, and 21, and sex chromosome aneuploidies, increase exponentially with maternal age starting in the 30s, reaching levels of 1.4 per cent at age 35, 1.9 per cent at 40, and 8.9 per cent at 45, according to amniocentesis data. Some of those contribute to the higher stillbirth rate resulting in a slightly smaller incidence of chromosome abnormalities in newborns. Overall, the literature supports the finding that women and their offspring experience significant increased problems as maternal age progresses through the mid-30s and beyond.(ABSTRACT TRUNCATED AT 400 WORDS)
267 citations
TL;DR: It is concluded that measurement of antibody to cardiolipin is the most sensitive assay to predict fetal distress or death in patients with systemic lupus erythematosus and may be of pathogenetic importance in this syndrome.
Abstract: During a prospective study of pregnancies in women with systemic lupus erythematosus, we examined the relation between antibody to cardiolipin, measured by the enzyme-linked immunosorbent assay, and midpregnancy fetal distress, identified by abnormal results of antepartum fetal heart-rate testing or by fetal death. All of nine patients with lupus and this complication had abnormally high antibody levels (mean, 212.3±55.3 units), as compared with values in normal nonpregnant women (28.2±10.1 units). None of 12 pregnant patients with lupus but without this complication had antibody levels above 50 units (mean, 27.5±3.4 units; P<0.005 vs. women with lupus and fetal distress); 4 of 12 pregnant subjects without lupus had antibody levels above 50 units (mean, 42.5±11.0), and fetal death occurred in the subject with the highest level. The mean antibody level in 12 nonpregnant patients with lupus was 117.4±35.0 units. Two patients who had lupus anticoagulant but not clinical lupus, both with histories of...
221 citations
TL;DR: Transdermal estradiol can elicit many of the desirable actions of estrogen while avoiding the pharmacologic effects of oral estrogens on hepatic proteins, according to a dose-response study in postmenopausal women.
Abstract: We conducted a dose-response study in 23 postmenopausal women to compare the physiologic effects of transdermal estradiol and oral conjugated equine estrogens. The doses studied were 25, 50, 100, and 200 micrograms of transdermal estradiol per 24 hours, and 0.625 and 1.25 mg of oral conjugated estrogens. Transdermal estradiol increased circulating concentrations of estradiol and estrone. Oral conjugated estrogens also raised the levels of estrogen, particularly estrone. Both preparations lowered gonadotropin levels, decreased the percentages of vaginal parabasal cells, increased the percentage of superficial cells, and lowered urinary calcium excretion. The effects of 0.625 and 1.25 mg of oral estrogens were similar to those of 50 and 100 micrograms of transdermal estradiol per 24 hours, respectively. Oral estrogens significantly increased circulating levels of renin substrate, sex-hormone-binding globulin, thyroxine-binding globulin, and cortisol-binding globulin; transdermal estradiol had no effect. The higher dose of oral estrogens had favorable effects on concentrations of low-density and high-density lipoproteins, but transdermal estradiol did not. Neither preparation affected any of the four clotting factors studied. These data indicate that transdermal estradiol can elicit many of the desirable actions of estrogen while avoiding the pharmacologic effects of oral estrogens on hepatic proteins.
198 citations
TL;DR: No benefits from estrogen use were observed in the study group; in particular, mortality from all causes and from cardiovascular disease did not differ for estrogen users and nonusers.
Abstract: We studied the effect of estrogen use on morbidity from cardiovascular disease in 1234 postmenopausal women, aged 50 to 83 years, participating in the Framingham Heart Study's 12th biennial examination (index examination). The medication history recorded at biennial examinations 8 through 12 was used to classify the degree of estrogen exposure before eight years of observation for cardiovascular morbidity and mortality. Despite a favorable cardiovascular risk profile and control for the major known risk factors for heart disease, women reporting postmenopausal estrogen use at one or more examinations had over a 50 per cent elevated risk of cardiovascular morbidity (P less than 0.01) and more than a twofold risk for cerebrovascular disease (P less than 0.01) after the index examination. Increased rates for myocardial infarction (P less than 0.05) were observed particularly among the estrogen users who smoked cigarettes. Conversely, among nonsmokers estrogen use was associated only with an increased incidence of stroke (P less than 0.05). No benefits from estrogen use were observed in the study group; in particular, mortality from all causes and from cardiovascular disease did not differ for estrogen users and nonusers.
169 citations
TL;DR: Vesicouterine fistula, while not common, is no longer rare, it occurs most often after low segment cesarean section and the major symptom is cyclic hematuria (menouria).
Abstract: Ninety-two cases of vesicouterine fistula reported in the world literature since 1908 are reviewed. The lesion was rarely seen before 1947. It usually followed a vaginal operative delivery and the usual complaint was total urinary incontinence. Diagnosis was most often made indirectly by seeing urin
156 citations
153 citations
TL;DR: It is demonstrated that clinically and histologically latent papillomavirus exists beyond the treatment area and that its presence influences subsequent recurrences.
Abstract: After anogenital condylomata and intraepithelial neoplasms are removed, they frequently recur Since these lesions are related to papillomaviruses, it has been suggested that latent papillomavirus infection is responsible for recurrence We studied 20 cases of anogenital lesions that were treated by laser therapy and analyzed biopsy specimens of margins of normal skin adjacent to the lesions for papillomavirus sequences by Southern blot hybridization In nine cases (45 per cent), papillomavirus sequences were detected in the normal skin margin; lesions recurred in 6 of the 9 patients (67 per cent), in contrast to only 1 of 11 patients (9 per cent) whose margins were negative for the presence of papillomavirus sequences All but one recurrence developed within 15 mm of the treatment area Our results demonstrate that clinically and histologically latent papillomavirus exists beyond the treatment area and that its presence influences subsequent recurrences
TL;DR: The CST, the NST, and fetal-movement monitoring are potentially useful screening tests, however, they require critical evaluation, with large randomized, controlled trials, to determine their efficacy and safety before their further diffusion into obstetrical practice.
Abstract: Published studies on the contraction stress test (CST), the nonstress test (NST), and monitoring of fetal movement were reviewed to assess the accuracy and efficacy of these techniques. The false-negativity and false-positivity rates, sensitivity, and specificity of these tests were assessed with use of perinatal mortality and various measures of morbidity as outcomes. Both the CST and the NST generally demonstrated low sensitivity and high rates of false positivity. No randomized controlled trials have been conducted that are of sufficient size to demonstrate whether there is a significant difference in outcome following use of the CST or the NST. A single nonrandomized, controlled trial evaluating fetal-movement monitoring suggested clinical benefit. Direct costs of NSTs and CSTs in the United States were estimated to exceed $200 million per year. Yet the CST and the NST have not been demonstrated to be useful diagnostic tests. The CST, the NST, and fetal-movement monitoring are potentially useful screening tests. However, they require critical evaluation, with large randomized, controlled trials, to determine their efficacy and safety before their further diffusion into obstetrical practice.
TL;DR: It is supported that the incidence of combined pregnancy may be much greater than formerly appreciated and cautioned in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy.
Abstract: Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine “rule-out ectopic” situations. A brief review of t
TL;DR: Current views on pathogenesis are discussed, methods available for prenatal diagnosis are described, and an approach to the possible prevention of congenital malformations are suggested.
Abstract: In spite of the overall improvement in the management of diabetic pregnancies, congenital anomalies among infants of diabetic mothers still remain two to three times higher than in the nondiabetic population. Approximately 40 per cent of all perinatal deaths among diabetic offspring are due to congenital malformations. This article reviews the subject and discusses current views on pathogenesis, based on human and experimental work, describes methods available for prenatal diagnosis, and suggests an approach to the possible prevention of these malformations.
TL;DR: This study has studied serial and family photographs of NS individuals in order to assess the likelihood of gene carriers' being missed in genetic studies and confirmed wide clinical variability within families, and suggests that the change of phenotype with age may have been falsely perceived as clinical heterogeneity.
Abstract: Among the multiple congenital anomalies (MCA) syndromes, the Noonan syndrome (NS) is a cardiofacial syndrome in which affected individuals may be short and mildly mentally retarded. Autosomal dominant inheritance of Noonan syndrome with variable expressivity has been documented in many families. Genetic heterogeneity has been postulated in Noonan syndrome because of the wide phenotypic variability, the relatively high incidence, and the occasional recurrence in sibs with apparently normal parents. Clinical variability is usual in autosomal dominant disorders, and mildly affected individuals may be difficult to recognize as gene carriers. Thus, a family with two or more affected children may simulate autosomal recessive inheritance. We have studied serial and family photographs of NS individuals in order to assess the likelihood of gene carriers' being missed in genetic studies. We have confirmed wide clinical variability within families, and more importantly, we have documented marked change of phenotype with age from the newborn period, infancy, childhood, and adolescence to adulthood. Manifestations in adults may be subtle and some without a known heart defect or other medically significant problems may have been considered normal in the past. Our study, while not ruling out causal heterogeneity, suggests that the change of phenotype with age may have been falsely perceived as clinical heterogeneity. A particular and subtle phenotype must be searched for in parents of affected children.
TL;DR: Early exploration and bilateral gonadectomy should be performed in patients with gonadal dysgenesis and Y-chromosome material in their karyotype, as they are at risk for development of ovarian neoplasm.
Abstract: We analyzed the clinicopathologic characteristics of 140 cases of neoplasia arising in dysgenetic gonads. These 140 cases were found on a review of the medical literature published between 1953 and 1983. The age of the patients at the time of diagnosis was recorded in 133 patients and ranged from 6 months to 45 years. The mean age at diagnosis was 18 years 8 months. Thirteen (9.8 per cent) patients were below the age of 10 at the time of diagnosis. A menstrual history was recorded in 109 cases. Amenorrhea was present in 103 (94.5 per cent). A Y chromosome or Y-chromosome fragment was present in 90.7 per cent of the 119 patients who had karyotype analysis. Bilateral tumors were found in 54 instances (38.6 per cent). Thus, a total of 194 neoplasms were found. Of these 103 (53.1 per cent) were gonadoblastomas, 38 (19.6 per cent) dysgerminomas, 34 (17.5 per cent), gonadoblastoma with areas of dysgerminoma, and 19 (9.8 per cent) were of other histologic types. Patients with dysgenetic gonads and Y chromosome material are at risk for development of ovarian neoplasm. A dysgerminoma of dysgerminomatous component was present in 37 per cent of the reviewed tumors. These neoplasms have been discovered as early as 6 months of age and 9.8 per cent of the cases occurred in patients below the age of 10. Early exploration and bilateral gonadectomy should be performed in patients with gonadal dysgenesis and Y-chromosome material in their karyotype.
TL;DR: The likelihood of repetition of preterm birth after spontaneous onset of labour has been studied in 6572 reproductive careers after excluding stillbirths, multiple births, all careers in which any labour had been induced, and all careers where the gestation length in any pregnancy was not certain.
Abstract: The likelihood of repetition of preterm birth after spontaneous onset of labour has been studied in 6572 reproductive careers after excluding stillbirths, multiple births, all careers in which any labour had been induced, and all careers in which the gestation length in any pregnancy was not certain. The analysis was controlled not only for pregnancy number, but for the nature of the reproductive outcomes. In most reproductive sequences there was a weak correlation between the gestation in one pregnancy and subsequent ones. The risk of preterm birth was tripled after one previous preterm birth with or without a preceding abortion, and increased six-fold after two previous preterm births. However, the attributable risk was low, and most multiparae with preterm births did not have a previous history.
TL;DR: Sixty-three pregnant patients treated for primary carcinoma of the breast at the Mayo Clinic between 1950 and 1980 had a greater incidence of nodal metastasis and scirrhous histopathologic factors than did non-pregnant patients with a malignant condition of the Breast.
Abstract: Sixty-three pregnant patients were treated for primary carcinoma of the breast at the Mayo Clinic between 1950 and 1980. These patients had a greater incidence of nodal metastasis and scirrhous histopathologic factors than did non-pregnant patients with a malignant condition of the breast. The five year survival rate of pregnant patients with localized malignant growths of the breast was 80 per cent. Improved survival time was not demonstrated for patients who terminated the pregnancy.
TL;DR: It is concluded that gonadotropin treatment will usually increase the sperm count to normal in men with hypog onadotropic hypogonadism, unless cryptorchidism has occurred.
Abstract: We evaluated the efficacy of gonadotropin treatment in stimulating spermatogenesis in men with hypogonadotropic hypogonadism When 21 men with hypogonadotropic hypogonadism were treated with human chorionic gonadotropin, the sperm count increased to within the normal range in the 6 in whom hypogonadism had begun after puberty, but in only 1 of the 15 in whom it had begun before puberty (P less than 0002) When the remaining 14 men with prepubertal hypogonadism were treated with human menopausal gonadotropin in addition to human chorionic gonadotropin, the sperm count increased to normal in 5 of the 7 who had not had cryptorchidism, but in only 1 of the 7 who had (P less than 005) The need for human menopausal gonadotropin as a replacement for follicle-stimulating hormone could not be predicted by pretreatment serum and urinary levels of follicle-stimulating hormone We conclude that gonadotropin treatment will usually increase the sperm count to normal in men with hypogonadotropic hypogonadism, unless cryptorchidism has occurred The need for human menopausal gonadotropin treatment appears to depend on the time of onset of hypogonadism
TL;DR: Time-velocity waveforms or sonograms obtained by pulsed Doppler ultrasound from the umbilical artery were analysed in a longitudinal study of 15 normal pregnancies and the sonograms from nine fetuses with intrauterine growth retardation were compared qualitatively.
Abstract: Time-velocity waveforms or sonograms obtained by pulsed Doppler ultrasound from the umbilical artery were analysed in a longitudinal study of 15 normal pregnancies. The sonograms from nine fetuses with intrauterine growth retardation were compared qualitatively and had quite different characteristics implying a high distal impedance to blood flow. Methods of analysis capable of differentiating between the normal and abnormal sonograms are described and discussed.
TL;DR: In this article, the differences in mean birth weight and low birth weight (less than 2.5 kg) were analyzed among Asians, blacks, Hispanics, and whites who were enrolled in the Northern California Kaiser-Permanente Birth Defects Study, a prospective study of 29,415 pregnancy outcomes.
Abstract: Differences in mean birth weight and low birth weight (less than 2.5 kg) are analyzed among Asians, blacks, Hispanics, and whites who were enrolled in the Northern California Kaiser-Permanente Birth Defects Study, a prospective study of 29,415 pregnancy outcomes. Large differences in birth weight among babies of different ethnic groups persist after controlling for the joint effects of maternal smoking and alcohol use during pregnancy, sex of child, parity, length of prenatal care, and maternal weight-for-height percentile. Compared with whites, the relative mean differences in birth weight are estimated as -246 g for blacks, -210 g for Asians, -105 g for Hispanics, and -140 g for others. The low-birth-weight rates and crude odds ratios are 7.70% (2.17) for blacks; 5.57% (1.57) for Asians; 5.52% (1.55) for others; 4.00% (1.13) for Hispanics; and 3.55% (1.00) for whites. After controlling for the effects of 22 factors, the odds ratios for a low-birth-weight infant are 2.41 for blacks, 1.37 for Asians, 1.93 for others, and 1.25 for Hispanics. It is concluded that factors currently used to control for ethnic differences in birth weight are insufficient to explain the observed differences.
TL;DR: It is inferred that the functional integrity of ovarian cyclicity is remarkably sensitive to brief (3 days) and partial reduction in pulsatile gonadotropin secretion, which disrupts folliculogenic processes and induces the demise of the corpus luteum.
Abstract: A potent GnRH antagonist, [Ac-delta 3-Pro1,p-F-D-Phe2,D-Trp3,6]GnRH (4F-Antag), was used as a probe to determine the relative dependency of ovarian cyclicity on pulsatile gonadotropin secretion. 4F-Antag was administered in a dose of 80 micrograms/kg sc twice a day for 3 consecutive days during different phases of the menstrual cycle. This treatment resulted in a prompt attenuation of pulsatile gonadotropin secretion in all women studied. Maximal suppression of gonadotropin levels, expressed as percent change from baseline, averaged 48% for LH and 22% for FSH. The reduced pulsatile gonadotropin release induced by 4F-Antag administration during the early follicular phase resulted in a significant decrease in serum estradiol levels during the period of treatment and was followed by a prolongation of follicular phase (2.4 days) and cycle length (3.5 days), but no alteration of subsequent cyclic ovarian steroid profiles compared to control cycles. Treatment initiated during the midfollicular phase 4-6 days before the expected LH surge resulted in a more dramatic decline in serum estradiol levels and prolongation of follicular phase length by 5-6 days compared to control cycles. Normal luteal function was preserved. These alterations were compatible with induction of the demise of the dominant follicle followed by the reinitiation of follicular recruitment. Administration of 4F-Antag during the midluteal phase resulted in rapid falls in serum estradiol and progesterone levels and the onset of menstrual bleeding in all women. The luteolytic effect of 4F-Antag was completely negated by the administration of hCG. These data indicate that 4F-Antag interferes with ongoing cyclic ovarian function by reducing pulsatile gonadotropin stimulation, which disrupts folliculogenic processes and induces the demise of the corpus luteum. From these findings we infer that the functional integrity of ovarian cyclicity is remarkably sensitive to brief (3 days) and partial reduction in pulsatile gonadotropin secretion.
TL;DR: Although traffic was decreased during periods of gown use, overgowns are an expensive, ineffective method of decreasing nosocomial infection rates, vascular catheter colonization rates, and breaks in handwashing technique.
Abstract: In a pediatric intensive care unit we conducted a 1-year prospective study of 454 patients to determine whether wearing a gown decreased the overall nosocomial infection rate, incidence of intravascular catheter colonization, breaks in handwashing technique, and traffic The overall infection rate was 26 (13%) of 198 admissions during the gown-wearing periods v 23 (9%) of 256 admissions for the periods when gowns were not worn (P less than 25) Of 348 intravascular catheter tips cultured 16 (46%) were colonized during gown-wearing periods compared with 21 (63%) of 330 when no gowns were worn (P less than 25) Of 78 patient contacts 54 (69%) were followed by no handwashing during gown-wearing periods and 59 (70%) of 84 contacts were followed by no handwashing during periods when no gowns were worn The mean occurrence of visits per patient per hour and total visits per hour differed between gown-wearing and no-gown-wearing periods by analysis of variance, P less than 01 and P less than 005, respectively Although traffic was decreased during periods of gown use, overgowns are an expensive, ineffective method of decreasing nosocomial infection rates, vascular catheter colonization rates, and breaks in handwashing technique
TL;DR: It is clearly documented that the risk of severe fetal complications is much higher if the hyperparathyroidism is left untreated than if the mother undergoes operation during the pregnancy, and when the diagnosis is established the mother should undergo operation, if possible during the second trimester, which minimizes the complication rate significantly in both mother and child.
Abstract: The history of a pregnant woman with primary hyperparathyroidism is presented. The patient underwent successful operation during the second trimester and the subsequent pregnancy and delivery were completely normal. Previously, 72 women with an established diagnosis of hyperparathyroidism in pregnancy are reported in the English literature. Twenty-three women underwent operation during pregnancy and 18 normal children were born. Fifty women with a total of 79 pregnancies during a hyperparathyroid state bore 35 normal children while 40 births had different kinds of complications. It is thus clearly documented that the risk of severe fetal complications is much higher if the hyperparathyroidism is left untreated than if the mother undergoes operation during the pregnancy. Therefore when the diagnosis is established the mother should undergo operation, if possible during the second trimester, which minimizes the complication rate significantly in both mother and child. Correction of the hypercalcemic state enables the development of adequate parathyroid gland function in the baby.
TL;DR: It appears that estrogen sensitivity is higher in the leiomyoma than in the corresponding myometrium, due to the relative increase in ER.
Abstract: To support the estrogen hypothesis in the patho-genesis of leiomyoma, total cellular estrogen receptor (ER) levels (the sum of levels in cytosol and nuclear KCl-extract-able and nuclear non-KCl-extractable fractions) were assayed and compared with levels of progestin (PR) and an-drogen (AR) receptors in the leiomyoma and the corresponding myometrium. The ratios of ER to PR or AR levels were higher (with statistical significance) in leiomyoma than in the corresponding normal myometrium, both in terms of total cellular levels in' each individual case and nuclear levels. It appears that estrogen sensitivity is higher in the leiomyoma than in the corresponding myometrium, due to the relative increasc in ER.
TL;DR: The data reviewed show that at present biparietal diameter measurements, nonstress test/oxytocin challenge test or hormone values do not contribute to a better IUGR prediction than when the above mentioned methods are applied.
Abstract: Several methods used in the diagnosis of intrauterine growth retardation (IUGR) were evaluated with epidemiologic techniques. The strong effect of IUGR prevalence on the positive predictive and false-positive values of these methods is discussed. If correctly used, the combination of clinical measurements and perinatal risk factors can have a predictive power as high as any of the other more sophisticated techniques. The data reviewed show that at present biparietal diameter measurements, nonstress test/oxytocin challenge test or hormone values do not contribute to a better IUGR prediction than when the above mentioned methods are applied. For IUGR detection, ultrasound evaluation should include ratios of anthropometric measurements and may be complemented with amniotic fluid volume assessment. It is suggested that these procedures be reserved to a selected high risk population. Efforts should be made to evaluate new technologies through randomized controlled trials before they are introduced to the general population, particularly in developing countries.
TL;DR: The chance of pregnancy for those couples where autoimmunity to sperm was the sole definable factor leading to infertility was 15.3% when most spermatozoa were antibody-bound and a significantly greater number of wives whose husbands had less than 50% of their sperm bound by immunoglobulins conceived.
Abstract: In men with autoimmunity to sperm, a varying proportion of spermatozoa in the ejaculate are found to have surface-bound immunoglobulins. We asked whether the extent of autoimmunity, as judged by this criterion, would have predictive value in determining the chance of conception. Infertile couples where husbands were found to have antisperm antibodies were treated for other factors leading to impaired reproduction, but no specific treatment was offered for reduction of these antibodies. The chance of pregnancy for those couples where autoimmunity to sperm was the sole definable factor leading to infertility was 15.3% when most spermatozoa were antibody-bound. A significantly greater number of wives whose husbands had less than 50% of their sperm bound by immunoglobulins conceived (66.7%; P less than 0.005).
TL;DR: It is concluded that hormonal therapy with either gonadotropin-releasing hormone or human chorionic gonadotropic hormone is, in most cases, ineffective in promoting testicular descent of true cryptorchid testes, however, short-term treatment with human chOrionic gonAdotropin is very effective in producing descent of retractile testes.
Abstract: We conducted a randomized, double-blind study comparing intranasal gonadotropin-releasing hormone (1.2 mg per day for 28 days) with parenteral human chorionic gonadotropin (3300 IU per week for four weeks) in the treatment of cryptorchidism in 33 boys one to five years old (29 with unilateral and 4 with bilateral cryptorchidism). Testicular descent into the scrotum occurred in 3 of the 16 patients (19 percent) treated with gonadotropin-releasing hormone and in 1 of the 17 (6 percent) treated with human chorionic gonadotropin (P = 0.23). The mean luteinizing hormone and testosterone levels were similar in both groups before treatment. During treatment, the testosterone levels were significantly increased in both groups, but higher levels occurred in the group treated with human chorionic gonadotropin (P less than 0.05). In a parallel (but uncontrolled) study of five boys with retractile testes (defined as a nonscrotal testis that could be manipulated into the bottom of the scrotum) who were originally excluded from the main protocol but were treated with the same regimen of human chorionic gonadotropin, descent into the scrotum occurred in all patients. We conclude that hormonal therapy with either gonadotropin-releasing hormone or human chorionic gonadotropin is, in most cases, ineffective in promoting testicular descent of true cryptorchid testes. However, short-term treatment with human chorionic gonadotropin is very effective in producing descent of retractile testes. These results suggest that the wide discrepancies in apparent efficacy in previous trials of hormonal therapy of cryptorchidism may have been due to inclusion in those studies of various proportions of patients with retractile testes.