Biomedical subjects
Publications and source records attributed to M L Tancer.
Sixty-seven cases of lower urinary tract genital fistulas were seen during the last 7 years. Of the 67 cases 45 (67 per cent) followed total hysterectomy, of which 43 were operated upon transvaginally using the Latzko technique of partial colpocleisis. There were 40 primary cures (93 per cent) and 3 failures (7 per cent), each of which was cured by a secondary Latzko operation. The advantages of the operation are discussed.
One hundred eight patients with "satisfactory" colposcopy, a histologic diagnosis of cervical carcinoma in situ and a stated desire to maintain fertility were treated by therapeutic conization performed under colposcopic guidance in the operating room. One patient had a recurrence of carcinoma in situ at 8 months, and two patients had mild dysplasia at 18 and 24 months. Fifteen patients conceived.
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A study to evaluate segmental epidural analgesia in labor is described. Bupivacaine (0.25 per cent) was used during the first stage of labor and for the second stage, either 3 per cent - Chloroprocaine delivered through the catheter (Group I) or 1 per cent Lidocaine as a perineal infiltrate (Group II) was used. There were 124 full term patients of whom, 36 were nulliparous and 88 were multiparous. The effects of segmental epidural analgesia on maternal blood pressure, pain relief, preservation of lower limb motor power, duration and progress of labor, and fetal outcome were evaluated. Pain relief during the first stage of labor was satisfactory in 114 (92 per cent) of the patients. There were no significant changes in maternal blood pressure, motor power in lower limbs, efficiency of uterine contractions and internal rotation of the presenting part when analgesia was effective. The use of 2-Chloroprocaine for second stage pain relief required low forceps delivery in 84 (91 per cent) patients, as compared to 14 (44 per cent) patients that had 1 per cent Lidocaine local infiltration. Fetal outcome, was excellent in all cases in that the one minute Apgar score was never lower than 7.
Laparoscopic tubal sterilization, using a Silastic band to occlude the tubal lumen, was performed on 224 patients. The incidence of complications was low and only 2 pregnancies occurred. Further evaluation by hysterosalpingography on 97 patients revealed 2 distinct images. The site of tubal occlusion was seen on laparoscopy performed on 7 patients. The radiographic and laparoscopic findings are discussed.
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Human amnion is a readily available and inexpensive allograft with low antigenicity, high antimicrobial potential, and the ability to foster epithelialization. It has been used to reconstruct the vagina in 2 patients following vaginectomy for diffuse carcinoma in situ (CIS) and in 1 patient following severe, corrosive, vulvovaginal burns. It was also used to construct the vagina in 1 patient with müllerian agenesis. In all 4 cases, epithelialization was complete within 8 weeks.
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Two patients exposed in utero to maternal DES ingestion presented with adenosis. Each developed intraepithelial neoplasia in an area of active metaplastic change. The question is raised whether a continuum exists beginning with DES exposure and proceeding through the occurrence of adenosis and active squamous metaplasia to dysplastic alteration and finally squamous neoplasia. Since the cytologic smear is negative in 50% of cases during the dysplastic phase, it is recommened that all cases of adenosis be followed by colposcopy.
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