Septic shock in obstetrics and gynecology. Identification and importance of the problem.
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Biomedical subjects
Publications and source records attributed to D Cavanagh.
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A case of intra-abdominal rupture of bilateral cystic teratomas in the first trimester of pregnancy is reported. Review of the literature revealed 22 cases of intraperitoneal rupture of benign cystic teratoma (1908 to 1971). In all of these cases only one ovary was involved, and the period of gestation was after the first trimester.
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In addition to the four major polypeptides VP1 and VP4, foot-and-mouth disease virus particles contain two minor polypeptides, mol. wt. 40 X 10(3) (P40) and 52 X 10(3) (P52). Extensive purification procedures failed to remove these minor polypeptides from the virus particles. Polypeptide P40 co-electrophoresed in SDS-polyacrylamide gels with VP0, the probable precursor of VP2 and VP4 and was inaccessible to iodination in situ. The second minor polypeptide, P52, co-electrophoresed with the virus infection associated (VIA) antigen found in large amounts in harvests of the virus grown in BHK 21 cells. Polypeptide P52 was shown to be located near the surface of the virus particle by iodination experiments and by its removal on incubating the particles with trypsin or chymotrypsin. Pactamycin mapping showed that this polypeptide was not a precursor of the structural polypeptides. About one copy of P52 and 4 copies of P40 were found in the virus particles sedimenting at 146S. However a larger number of copies was found in those virus particles sedimenting faster than the 146S peak.
One hundred patients with abnormal cytology were evaluated by colposcopy, and histologic material was obtained by directed biopsies, cold knife conization and endocervical curettage. The colposcopy directed biopsies provided the diagnosis in 94 per cent of the patients, and the colposcopic impression was accurate in 89 per cent of the patients. Cold knife conization was performed in 98 patients, since two patients had invasive carcinoma on colposcopic directed biopsy. In 75 patients, the histopathologic finding on cone biopsy was in complete agreement with the directed biopsies. In 11 patients, the directed biopsies were a degree higher than on cone biopsy, and in six patients the histopathologic findings were a degree lower. In six patients the colposcopic directed biopsies missed the diagnosis of dysplasia. No patients with carcinoma in situ or invasive carcinoma were missed by the colposcopic directed biopsies.
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Forty-patients with advanced gynecologic cancer were treated with two different regional chemotherapeutic techniques. They were divided into two comparable groups. Twenty were treated by isolated regional perfusion and 20 were treated by intra-arterial infusion. The simple technique of intra-arterial infusion had a much lower mortality rate and gave equally satisfactory results when compared with the more complicated "closed" pelvic perfusion method. This comparative study suggests that the further use of isolated pelvic perfusion should await improvements in techniques and the development of more rapidly acting drugs. Further efforts in the area of infusion should be directed toward the development of more rapidly acting drugs, the development of better tumor-cytotoxic drug sensitivity tests, better use of the newer knowledge of cellular kinetics, and improved techniques for accuracy in the placement of arterial infusion catheters. While it is felt that regional chemotherapy has a place in management, it is not being proposed as a substitute for surgery or radiotherapy in the patient who will benefit from orthodox treatment.
Fetus papyraceus is a rare condition occurring in both monochorionic and dichorionic multiple gestations. Assocated with case presented were two interesting and uncommon findings: velamentous insertion of the umbilical cord of the blighted fetus and a congenital abonormality of the surviving fetus. This case is the first known intrauterine monitoring of a pregnancy involving a fetus papyraceus with serial plasma estriol and human placenta lactogen determination.
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