Biomedical subjects
Publications and source records attributed to J L Breen.
All practitioners must become more familiar with the practice of gynecology in the elderly in order to better serve their patients, of whom an increasing proportion are geriatric gynecologic patients. Advances in medical technology have increased the average life span, and better understanding of "senescent changes" may make it possible to improve the quality of life as well.
Methoxyflurane is utilized in obstetrics for analgesia during labor. It has been recognized as an unpredictable hepatotoxin. Although hepatitis has been seen after its use in anesthesia, only one case of hepatitis has been reported after its use for analgesia in labor. Two more cases of hepatitis following methoxyflurane analgesia are reported. Direct toxic effects of its metabolites and host idiosyncrasy may underlie the hepatic injury from methoxyflurane.
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Forty patients with placenta accreta, increta, or percreta are presented. Clinical features revealed an average age of 29.5 years and an average parity of 3-2-1. Twenty-five had no antepartum complications. Nine were admitted with silent hemorrhage, of which 6 had a total placenta previa and 1 a low-lying previa. Postpartum hemorrhage occurred in 39% with an associated perinatal mortality of 25% and 1 maternal death. Histopathologic evaluations revealed the predominant factor to be an absent decidua. Etiologic in decidual deficiency was a previous cesarean section (12 patients). Therapy consisted of total abdominal hysterectomy in 38 patients.
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Three cases of sacrococcygeal teratoma of the neonate occurred during a two-year period in which approximately 6,000 live births occurred in our hospital. Two infants were delivered vaginally and one by cesarean section. One infant underwent immediate surgery and survived, whereas the other two were in too poor condition to warrant surgery. Early excision is the treatment of choice; radiotherapy and chemotherapy are not effective in the malignant variety of sacrococcygeal lesion.
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