Biomedical subjects
Publications and source records attributed to H Zakut.
Hemangiopericytoma is a rare vascular tumor that can be found in almost every site or organ in the body. To our knowledge, however, this is only the third reported case of hemangiopericytoma of the vulva.
The hemodynamic stable patient suspected of extrauterine pregnancy may be a diagnostic challenge. Dilatations and curettage, Douglas puncture and laparoscopy are significant diagnostic aid in the investigation of the suspected ectopic pregnancy patient; but they are among the invasive methods. The introduction of non invasive methods such as serum beta subunit hCG and sophisticated ultrasound techniques seems to institute a more conservative approach to the "stable patient" prior to exposing her to anaesthetic and operative risks. A prospective study on "stable patients" suspected of "subacute" extrauterine pregnancy was undertaken in order to assess the diagnostic usefulness of a suggested non invasive protocol to determine whether its use has an advantage over the traditional invasive methods. 108 patients were evaluated in this study. 31 women were managed according to the non invasive protocol; patients presenting positive sonography signs underwent immediate operative procedure, patients in whom sonography revealed suggestive signs of E.U.P., expectant management was undertaken till serum beta subunit hCG confirmed or excluded the diagnosis. 77 patients were managed according to the invasive method protocol. Results indicate that the non invasive protocol has high diagnostic accuracy. Among the 31 patients no unnecessary intervention was performed. On the other hand, among the 77 patients, 43 laparoscopies were unnecessary.
Jaundice complicating severe bacterial infection has already been described; much less common is its occurrence as the presenting symptom of severe sepsis. A case is presented describing a patient who developed rapid increasing jaundice on the 4th day after an elective cesarean section, accompanied by deterioration in her general status. Various diagnostic means (abdominal CT, ultrasound investigation and hepatosplenic scanning) were performed in order to confirm or rule out the possibility of intraabdominal sepsis and the only finding on physical examination, being the absence of peristaltics. In spite of negative results of all the image processing techniques the patient underwent an explorative laparotomy on the 6th day, which revealed a generalized purulent peritonitis. It should be emphasized that: Severe jaundice maybe the presenting symptom of sepsis. False negative results of several modern image processing procedures may mislead the diagnostic approach and the subsequent therapeutic methods.
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The direct effect of gonadotropin releasing hormone (GnRH) upon ovarian function, is initiated by a rapid receptor-mediated increase in phosphatidylinositol (PI) turnover (approximately 5 min) followed by prostaglandin E (PGE, 120 min) and progesterone (120 min) formation, oocyte maturation and induction of ovulation. In contrast, luteinizing hormone (LH) stimulation of oocyte maturation and induction of ovulation is mediated by increased adenosine 3',5'-monophosphate (cAMP, 15 min), progesterone (30 min) and PGE (180 min) production. Both LH and GnRH stimulation of oocyte maturation are inhibited by dibutyryl cAMP and 3-isobutyl-1-methylxanthine, whereas induction of ovulation by the two hormones is blocked by indomethacin. GnRH and LH differ, therefore, in the mechanism leading to PGE formation, but thereafter share a common mechanism responsible for oocyte maturation and independently for induction of ovulation.
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The direct effects of gonadotropin releasing hormone (GnRH) upon testicular function include a rapid (integral of 20 min) receptor-mediated increase in phosphatidylinositol (PI) turnover. Incubation of rat interstitial cells with the super-agonist [D-Ala6]desGly10-GnRH N ethylamide (GnRHa) resulted in increased incorporation of [32P]Pi into PI (2-fold at 20 min). The effect on phospholipid turnover was followed by increased prostaglandin E (PGE) and testosterone production (3 h; with ED50 values of 0.5 and 0.75 nM respectively). It is concluded that increased PI turnover and PGE production might be involved in mediating the direct testicular effects of GnRH and its agonists.
The early direct effects of GnRH on the ovary were investigated using cultured granulosa cells from preovulatory rat follicles, and compared to the known stimulatory effects of LH. Stimulation of ovarian functions by a GnRH agonist include a rapid receptor-mediated phosphatidylinositol turnover (approximately 5 min). On the other hand, LH action on granulosa cells is initiated by increased cAMP production (approximately 10-15 min), consisting of an indomethacin-resistant and indomethacin-sensitive pools (40% and 60%, respectively). The GnRH agonist [D-Ala6] des-Gly10 N-ethylamide (GnRHa) at concentrations of 10(-12)-10(-8) M had no effect on basal or LH-stimulated cAMP production during a 4-h incubation test. Both LH and GnRHa increase progesterone formation (30 and 120 min, respectively) with ED50 values of 2.5 ng/ml and 10(-9) M, respectively and the stimulatory effect is not blocked by indomethacin. LH and GnRHa increase also prostaglandin E (PGE) formation (180 and 120 min, respectively) and the ED50 values were 0.1 microgram/ml and 10(-9) M, respectively. No inhibitory effect of GnRHa on LH actions was observed during 4 h of incubation. It is concluded that: 1) GnRH mimicks LH stimulation of ovarian PGE and progesterone production; 2) cAMP does not play a role in mediating the direct stimulatory effects of GnRH agonists on ovarian PGE and progesterone production; 3) PGE is not involved in mediating GnRH and LH stimulation of progesterone formation. 4) LH-induced cAMP production consists of indomethacin-sensitive and indomethacin-resistant pools.
The early direct effects of a GnRH agonist analog [D-Ala6]des-Gly10-GnRH N ethylamide (GnRHa) on rat testicular interstitial cells include increased production of prostaglandin E (PGE) and testosterone (T) at 3 h (ED50 values of 0.5 and 0.75 nM, respectively). On the other hand, LH action on testicular function, which is mediated by increased cAMP, involves an increase in T production at 30 min followed by increased PGE formation at 3 h. GnRHa at concentrations of 10(-12)-10(-8) M had no effect on basal or LH-stimulated cAMP production during a 4-h incubation test. The stimulatory effect of GnRHa on PGE, but not on T production, was abolished by the prostaglandin synthesis inhibitor indomethacin (1.5 microns). We conclude that cAMP does not play a role in mediating the direct testicular effects of GnRH on PGE and T production; that PGE is not involved in mediating GnRH-induced T production; and, finally, that increased PGE and T production might be involved in mediating the direct inhibitory and stimulatory testicular effects of GnRH and its agonist analogs.
A case of umbilical cord laceration and placental damage during amniocentesis for maturity studies is presented, with a review of the complications of amniocentesis.
Ultrasonography was used to measure the width of the internal os in 96 pregnant women, of whom 43 were considered to have cervical incompetence and were scheduled for cerclage. The remainder of the women were divided into two control groups: (a) 28 women with a normal obstetric history, and (b) 25 women with a history of either previous abortion or traumatic delivery. The mean width of the internal os in the three groups was 25.9 mm +/- 3.7, 15.8 mm +/- 2.7, and 18.2 mm +/- 6.5 respectively; statistically, significant difference were seen between the first group and each of the control groups. All the women in the first control group gave birth successfully at term; of those in the second control group, 5 presented with premature rupture of the membranes. The mean cervical os width in these 5 women was 29 mm, as compared with a mean of 18.2 mm for this group as a whole. We suggest that ultrasonic measurement of the internal os during pregnancy can be a useful and objective new method for the diagnosis of cervical incompetence.
A case of polyhydramnion in early pregnancy diagnosed by ultrasounds is here discussed and shown for its rarity and its very interesting clinical experience.
Electronic fetal heart rate monitoring has become a routine examination to assess fetal well-being. This report presents an unusual case in which maternal heart rate tachycardia was obtained from a dead fetus and was interpreted erroneously. The dead fetus conducted maternal ECG even through a scalp electrode by amplifying the input signal through the Automatic Control system of the monitoring equipment. The importance of concomitant maternal radial pulse recording or a real time scan is stressed.
A rare case of septic puerperal pelvic thrombophlebitis is presented. This condition is an uncommon but potentially serious complication of pyogenic pelvic infection. The purpose of this report is to describe a particular form of septic pelvic thrombophlebitis (SPT) that frequently eludes diagnosis because of the absence of positive abdominal or pelvic findings. Our recent experience with this entity is interesting, because of the striking effect of heparin after many days of unsuccessful high dose multiple antibiotic treatment.
The Authors report on a case of colon carcinoma occurred in a pregnant woman. As complaints for digestive tract disfunctions are common during pregnancy, the diagnosis of the malignancy was delayed. The Authors suggest the treating physician be alert to avoid under estimation of symptomatology.
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The dynamics of gonadotropin releasing hormone (GnRH) induced luteinizing hormone (LH) release was studied in vitro by superfusion of cultured pituitary cells. Continuous exposure of the cells to GnRH resulted in desensitization of the gonadotroph responsiveness to further stimulation by the hormone. The refractory state was achieved within 4 hr of hormone introduction (10(-7) M) and was accompanied by down-regulation of GnRH receptors (50%) assayed by equilibration with [125I]iodo-[D-Ala6]des-Gly10-GnRH N-ethylamide. The data indicate that GnRH can regulate the number of its own receptors, and that desensitization is accompanied by down-regulation.