Subcutaneous drainage and wound infection after appendectomy. A retrospective study.
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Adolescent↗
Biomedical subjects
H J Carp
Publications and source records attributed to H J Carp.
Vasa previa: a major complication and its management.
Vasa previa is an extremely rare condition. Consequently it is not often considered in the differential diagnosis of antepartum or intrapartum hemorrhage. Rupture of a fetal vessel may lead to sudden fetal death from exsanguination; therefore, this condition should be suspected in any antepartum or intrapartum hemorrhage. The blood that is lost should be tested for the presence of fetal hemoglobin. Other diagnostic tests to assess the degree of fetal distress are described. Four patients showing unusual presentations of vasa previa are reported. These cases demonstrate that fetal vessel rupture may occur independently of membrane rupture.
Adult↗
Immunotherapy of habitual abortion.
Many cases of habitual abortion have been assumed to be due to hyporesponsiveness to the spouse's antigens encountered in pregnancy. Immunization by paternal leukocytes has been used to potentiate the immune response and prevent further miscarriages. This treatment has been highly controversial in terms of efficacy, mode of action, and side effects. More recently immunoglobulin has been used as passive immunization for similar indications. In our experience immunotherapy is effective; 80% of patients have subsequent live births. The most significant results are seen in patients with five or more abortions, in whom 66% of subsequent pregnancies develop normally compared to 20% in a control group. We have used antipaternal complement-dependent antibody (APCA) production after immunization as a marker of immune response. APCA correlates with beneficial outcome in the next pregnancy. APCA may also be associated with cytokines, which may enhance embryonic and trophoblast development. Immunoglobulin may similarly provide the relevant antibodies or cytokines. At present a large scale meta-analysis is being performed to confirm or refute the efficacy of this treatment. This meta-analysis may resolve the controversy.
Abortion, Habitual↗
Effect of paternal leukocyte immunization on implantation after biochemical pregnancies and repeated failure of embryo transfer.
PROBLEM: It is unclear how paternal leukocyte immunization prevents pregnancy loss. We investigated whether immunization affects early pregnancy, and whether it increases the rate of implantation and early embryonic development at the time of implantation. METHOD: Three groups of women with possible implantation failure were immunized: (1) recurrent biochemical pregnancies (> 3), (2) three or more failed in vitro fertilization (IVF) cycles, and (3) IVF after immunization for recurrent abortion (> 3). Patients were immunized if antipaternal complement-dependent antibody (APCA) was negative, and mixed lymphocyte culture hyporeactive to husbands lymphocytes. Immunizations were prepared from 100 ml paternal blood separated by Ficoll Hypaque density centrifugation. IVF was attempted after APCA was produced. RESULTS: In the women with biochemical pregnancies, 10 to 12 subsequent pregnancies developed normally. Seventy-nine subsequent IVF cycles in 33 patients resulted in 20 pregnancies, 16 of which developed normally. Six pregnancies followed 30 cycles in recurrent failed IVF, and 14 pregnancies from 49 cycles in 23 patients with previous habitual abortion. CONCLUSIONS: This treatment may prevent further biochemical pregnancies if control studies confirm this preliminary observation, but was not shown to affect recurrent failed embryo transfer.
Abortion, Habitual↗
The clinical features and incidence of concurrent intra and extra uterine pregnancies.
Concurrent intra and extrauterine pregnancies have always been thought to be rare with a mean annual incidence of 1:30.000. The condition has been reported more frequently in the recent literature. If the incidence is increasing it is a serious development as the condition is often undiagnosed. The paper describes 5 patients with the condition presenting between 1976-1981 an incidence of 1:4000 deliveries. In two of these five patients the intrauterine pregnancy was diagnosed first and the ectopic pregnancy was undiagnosed until much later. The presence of intrauterine pregnancy often leads us to ignore the possibility of a concurrent extrauterine pregnancy. Considering that ectopic pregnancy may still cause maternal death, we believe that the condition has to be considered more often. Certain features may suggest the diagnosis. 1) Lack of vaginal bleeding or uterus larger than 9 week size with a proven ectopic pregnancy. 2) Presence of two corpora lutea at laparoscopy. 3) Ultrasound to diagnose an adnexal mass. 4) Failure of serum hCG to return to normal after abortion. The text also discusses the natural history of the condition and the higher incidence expected in the future with the wider use of ovulation inducing agents.
Adult↗