The assessment of persistent bradycardia in prenatal life.
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Biomedical subjects
Publications and source records attributed to B Piura.
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Marked decrease in fetal heart rate variability during labor was observed in a term fetus, borne by a mother with severe hypocalcemia due to idiopathic hypoparathyroidism and nutritional vitamin D deficiency. During the period of decreased baseline variability, fetal scalp pH was normal. A marked increase in fetal heart rate variability was observed within 5 minutes of intravenous administration of 1 gram calcium gluconate to the parturient. It seems that the recognition of the effect of maternal hypocalcemia on baseline fetal heart rate variability is important for accurate interpretation of fetal monitor tracing.
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We report the case of a 66-year-old postmenopausal woman who underwent unilateral oophorectomy for an ovarian endometrioid carcinoma with an unusual adenofibromatous stromal reaction pattern. She is presently alive, well and without clinical evidence of tumour two years after surgery. Adenofibromatous or cystadenofibromatous reaction is a peculiar reactive ovarian stromal change most probably induced by the invading neoplastic epithelial cells. No definite conclusions have been reached regarding the prognostic significance of this special stromal tissue reaction in cases of endometrioid carcinoma of the ovary.
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The feasibility of applying elevated Chlamydia trachomatis specific IgG antibody and serum IgA antibodies as a non-invasive screening test for C. trachomatis associated salpingitis was analysed in 54 salpingitis patients and 294 apparently healthy women by the single antigen (L2) immunoperoxidase assay (IPA). The prevalence rate of C. trachomatis IgG antibody (titre greater than or equal to 64) was significantly higher in the salpingitis patients in comparison to control (67% versus 23%). The prevalence rate of elevated C. trachomatis IgG titres (greater than or equal to 128, greater than or equal to 256 and greater than or equal to 512) was significantly higher in the salpingitis patients as compared to the controls. For example, at an IgG titre of greater than or equal to 128 the prevalence rate was 57% in the salpingitis patients and 8% in the healthy controls (p less than 0.0001). The prevalence of C. trachomatis IgA antibodies (titre greater than or equal to 16) was significantly higher in salpingitis patients in comparison to controls (37% versus 4%). The prevalence of elevated IgA titres (greater than or equal to 32 and greater than or equal to 64) was found to be significantly higher in salpingitis patients as compared to controls. All the IgG seropositive salpingitis patients were also found to have C. trachomatis IgG antibodies. It appears that testing for IgG antibodies at a serum dilution of 1:128, and for IgA antibodies at a dilution of 1:16 by the IPA test comprises the best combination for the differentiation between the salpingitis patients and apparently healthy controls, and it is suggested that this be used as a marker of active C. trachomatis infection.
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The effects of equivalent doses of two inhibitors of the 3-beta-hydroxy steroid dehydrogenase enzyme system--WIN 24540 (trilostane) and WIN 32729--on the secretion of progesterone in early human pregnancy are described. Patients and controls less than 12 weeks pregnant were given a single dose of either drug and the resultant hormonal changes monitored for 7 1/2 h. A consistent fall in plasma progesterone concentrations occurred at all doses and, at the highest dose, they fell to less than 50% of pre-treatment levels. However, whilst with trilostane the associated increase in plasma concentrations of pregnenolone was always accompanied by a rise in plasma DHA concentrations, with WIN 32729 there appeared to be no adrenal effect at the lower dosage levels. These data demonstrate inhibition of progesterone secretion in human pregnancy using non-hormonally active steroids. The pattern of steroid precursors indicates that while both drugs inhibit 3-beta-hydroxy steroid dehydrogenase activity, WIN 32729 is more selective and only interferes with adrenal steroid biosynthesis at high doses.
Congenital anomalies originating in the mullerian ducts are among the causes of gynecological and obstetrical disturbances that are commonly overlooked. These cases reach the rate of 1,1--3.5 per cent in hysterographic examinations. Some authors have stressed the need to keep this type of lesion in mind and to try to diagnose these conditions correctly, especially when the patients are examined for trivial complaints in the non-pregnant state, as well as during the prenatal period, or after delivery. The case presented in a multiparous Beduin woman with simultaneous pregnancies in both cavities of an unexpected didelphys uteri. The first twin, female 2,000 gram, was born at home, and the second, female 2,250 gram by cesarean section, following unsuccessful attempts at vaginal delivery. The decision to undertake surgery was taken for common obstetrical reasons like inertia uteri and high presentation. Proper early diagnosis should result in adequate management and the earlier end of labor.
The cervical balloon (Embrey & Mollison) was used to induce labor in a study group of 87 patients. The control group included 97 patients, where induction of labor was performed using oxytocin-drip. In the study group oxytocin-drip was added in 34 patients. The cases of the study and control groups were classified as "favorable" cervix. The patients classified as "unfavorable" cervix showed a shorter mean induction-delivery interval in the study group, and a shorter mean duration of oxytocin-drip in the cases of the study group where it was needed. It was concluded that the cervical balloon is a convenient method for the induction of labor, for its effectivity, simplicity and innocuity, especially in the "unfavorable" cervix cases.
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The cases of two patients with epithelial ovarian carcinoma who had been treated with surgery and cisplatin-containing combination chemotherapy and had developed brain metastases are described. Modern protocols for management of advanced-stage epithelial ovarian carcinoma have resulted in prolonging the lives of the patients sufficiently for central nervous system metastases to become apparent and possible resistence of the 'blood brain' barrier to the currently used chemotherapeutic agents may have left the CNS 'unprotected' from metastases.
Topotecan has demonstrated antitumor activity in heavily pretreated patients with ovarian carcinoma. This report examines the activity and toxicity of topotecan in 29 heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma. Topotecan 1.5 mg/m2 was administered intravenously on days 1-5, every 21 days. It was second-line chemotherapy in 6 (20.7%) patients, third-line in 15 (51.7%), fourth-line in 4 (13.8%), fifth-line in 3 (10.3%), and seventh-line in 1 (3.4%). Median dose intensity was 1.667 mg/m(2)/week, and median relative dose intensity was 0.67. Disease complete response was observed in 5 (17.2%) patients, partial response in 1 (3.4%), stable disease in 12 (41.4%), and progressive disease in 11 (37.9%). CA-125 complete response was observed in 3 (10.3%) patients, partial response in 11 (37.9%), stable level in 5 (17.2%), and progressive level in 9 (31%), and no data were available in 1 (3.4%) patient. Toxicity was mainly hematologic: grade 3-4 neutropenia was observed in 20 (69%) patients, grade 3-4 leukopenia in 12 (41.4%), grade 3-4 thrombocytopenia in 9 (31%), and grade 3-4 anemia in 2 (6.9%). It is concluded that topotecan has considerable activity and noncumulative hematologic toxicity in heavily pretreated patients with recurrent ovarian, peritoneal, and fallopian tube carcinoma.