Biomedical subjects
M Lancet
Publications and source records attributed to M Lancet.
Female pseudohermaphroditism with adrenal cortical tumor in adulthood.
Data are presented concerning a case of female pseudohermaphroditism of unknown etiology. The child was born with labioscrotal fusion and clitoromegaly. From the age of 5 to the age of 25 there was no clinical evidence of a hormonal abnormality. At the age of 25 the patient presented with masculinization and Cushing's syndrome, and a left adrenal tumor was removed. The patient was restudied at the age of 29, when 21-hydroxylase deficiency was excluded. Other types of congenital adrenal hyperplasia are considered unlikely. The possible relationship between the ambiguous genitalia present at birth and the virilizing tumor diagnosed at the age of 25 is analyzed.
Management of puerperal separation of the symphysis pubis.
Thirteen post-partum patients with symphysiolysis were treated by intra-symphysial injection of a combination of hydrocortisone, chymotrypsin and lidocain. The injection was given once a day and the full treatment consisted of between three to seven injections according to the severity of the symptoms. No other medication was given. Immediate relief was obtained in all cases after the first injection and all symptoms disappeared after the completion of treatment. The average time of hospitalization was 9.8 days. No complications were seen as a result of the treatment and the patients resumed their normal activities after being discharged from hospital. In comparison with other modes of treatment, the intra-symphysial injection of the above drug combination shortened the time of morbidity and effected complete recovery.
Uterine sarcoma in Israel: a study of 104 cases.
Data gathered during the first epidemiologic study of sarcoma of the uterus in Israel are presented. In the 7-year period of this survey, 104 new cases of sarcoma of the uterus were diagnosed, representing an incidence of 1.55/100,000 females over the age of 20. Half of the patients were in their fifth and sixth decades of life at the diagnosis of the tumor. Uterine sarcomas were more prevalent in women of European-American origin than in those of Asian-African descent. In 54.9% of the patients the diagnosis was made while the disease was in stage I. A definite correlation between sarcoma of the uterus, diabetes, hypertension, and obesity was not found. The 5-year survival rate in the present survey was 38%. Factors affecting prognosis were the clinical stage of the disease at diagnosis, histologic type, and the method of treatment.
A novel approach to the analysis of risk factors in endometrial carcinoma.
Early diagnosis of endometrial carcinoma enables one to achieve a cure rate of 80%. The purpose of this study is to characterize the patients who are prone to develop adenocarcinoma by simple epidemiologic and clinical data. The data of 109 consecutive patients who developed adenocarcinoma were compared with those of 146 control hysterectomy patients using logistic regression analysis. The following characteristics of patients who developed adenocarcinoma were identified: parity (P less than 0.0001), diabetes mellitus (P less than 0.003), hypertension (P less than 0.0001), obesity (P less than 0.0006), treatment with exogenous estrogen (P less than 0.001), and second primary tumor. The logistic regression formula classified correctly 77% of all patients to their actual group. The study showed that the relative risk of a patient to develop adenocarcinoma can be estimated from simple and readily available epidemiologic and clinical data.
Lymphoid cells and granulocyte progenitors in early human fetal livers: immunological parameters and in vitro cellular interactions.
Human fetal liver (HFL) transplantations have been performed in infants with severe combined immunodeficiency and in patients with aplastic anemia, but the success rates have been extremely low, partly due to insufficient cell doses in grafts from a single donor. In order to explore the possible use of combining several HFL grafts from multiple donors, we studied immunological parameters as well as the in vitro responses of HFL cells from 20 fetuses, at 6 to 11 weeks of gestation, to allogeneic HFL cells and to adult lymphocytes in the mixed lymphocyte reaction (MLR), and the granulocyte-macrophage colony-forming cells (GM-CFC) assay. HFL cells of 6 to 11 weeks of gestation were found to lack populations of cells bearing surface markers of T- and B-lymphocytes and were capable of proliferating into lymphoid colonies. Virtually no MLR was found to allogeneic HFL cells or to adult lymphocytes [stimulation index (SI) 0.63 to 1.94], whereas adult lymphocytes responded normally to HFL cells (SI 3.9 to 62.0). Coculturing mixtures of allogeneic HFL cells in agar did not lead to suppression of the GM-CFC capacity of each liver. It appears that HFL at 6 to 11 weeks of gestation lack immunocompetent cells capable of provoking positive MLR in response to allogeneic HFL cells or to adult lymphocytes, and also capable of inactivating HFL-derived hematopoietic stem cells. This model may represent an in vitro counterpart for the in vivo pooling of HFL cells from multiple donors performed in order to increase graft cell dosage in man.
Teratogenicity of progestogens given during the first trimester of pregnancy.
Possible teratogenic effects of exogenous progestational agents given during early pregnancy were investigated by a controlled historic prospective study of 2754 infants born to mothers who had bled during the first trimester of pregnancy. The study group consisted of 1608 newborns whose mothers had been treated with progestogens (mostly medroxyprogesterone acetate) beginning in the first trimester. The control group comprised 1146 infants of untreated mothers. All newborns were subjected to thorough examination during the first days of life, with special attention to detection of various malformations classified according to the different anatomic systems. No significant difference was found between the treated and the control groups with respect to malformations in any of the systems examined. The overall rate of malformations was 120 per 1000 in the study group and 123.9 per 1000 in the control group. Major malformations occurred at rates of 63.4 and 71.5 per 1000, respectively. The study thus fails to demonstrate an increase in teratogenicity after administration of gestagens during the first trimester of pregnancy.
[The importance of colposcopy in pregnancy].
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[Prophylactic mezlocillin therapy in cesarean section].
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Regulation of in vitro granulopoiesis by human fetal liver stromal cells.
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Absence of teratogenicity of indomethacin in ovarian hyperstimulation syndrome.
Eight women were treated for ovarian hyperstimulation syndrome (OHSS), grades 2-4, with indomethacin. The treatment was initiated 2-7 days after human chorionic gonadotropin administration and the period of treatment ranged between 3-8 days. The total dose was between 700-1200 mg. Nine live babies were born weighing between 2200-3950 gr. Except for a mild degree of hypospadias in one baby, there were no congenital malformations. This seems to indicate that indomethacin given under the described conditions has no apparent teratogenic effect.
Prevention of reformation of pelvic adhesions by "Barrier" methods.
Twenty-five female rabbits received symmetrical injuries on both uterine horns. Ten days later the animals were re-operated and the adhesions were lysed and covered on one of the uterine horns with silicone in ten animals (Group A) and with Surgical in ten other animals (Group B). The contralateral uterine horns served as internal controls and five animals in whom no barrier was used served as an external control (Group C). The silicone was removed in a third operation ten days later. A scoring method was used for the quantitation of the adhesions. The reformation of adhesions on the treated side was reduced in Group A (mean score 1.4 +/- 1.5) and increased in Group B (mean score 3.8 +/- 0.43) in comparison with Group C (mean score 2.5 +/- 1.03) (P less than 0.02).
[Hysteroscopy--a method of diagnosis and treatment].
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[Termination of anencephalic pregnancies].
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[Ritodrine for uncoordinated uterine activity].
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[The contraceptive pill and vascular accidents].
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Treatment of premature labor contractions with combined ritodrine and indomethacine.
The results of combined ritodrine and indomethacine treatment (RI) in premature labor contractions were compared with ritodrine alone (R). One hundred and twenty patients with threatened premature labor in weeks 26-34 were studied. Sixty RI women received 100 mg ritodrine in infusion followed by 60 mg daily orally until 35 weeks and indomethacine 200 mg on the first day of treatment only. The R group included 60 women with identical tocolysis indices, age of pregnancy and anamnestic parameters who received ritodrine only. The mean prolongation index (PI) was 18.2 in the RI group, against 11.5 in the R patients (P less than 0.05). The mean prolongation of pregnancy was 5.6 weeks in the first and 3.6 in the control group (P less than 0.05). Birthweight and Apgar scores were similar in the two groups. In order to examine the possible early closure of the ductus arteriosus due to the indomethacin therapy, echocardiograms were done on all newborn in the RI group: the pre-ejection period and right ventricular ejection time ratio was 0.19-0.26 after delivery and 0.17-0.22 1 month later, which excludes pulmonary diastolic hypertension due to premature closure of the duct. The combined RI treatment is more effective that R alone and does not give rise to any complications in the mother or the fetus.
Non-aggressive management of post-date pregnancies.
A non-aggressive approach to the management of post-date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less. Dates had been established with certainty in each case. In half of the patients (the study group) no time limit was imposed on the pregnancy, but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following: fetal movement count recorded daily by the mother, an oxytocin challenge test, and amnioscopy. The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score. In the 78 control patients labor was induced surgically on day 294, even if the pelvic score was low. In the study group, labor started spontaneously in 52 patients; labor was induced in 17 women after they showed an elevated pelvic score, in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed. There were 7 cesarean sections in the study group compared with 16 in the control group (P less than 0.05). The average duration of labor was 6.7 h in the study group, compared with 9.4 h in the control (P less than 0.01). There was no significant difference between the two groups with regard to meconium staining during labor, pathologic fetal heart rate, or the 5 min Apgar score. In the study group there was one neonatal death as a result of severe congenital heart disease, and in the control group one infant died due to asphyxia. It is concluded that conservative management of prolonged pregnancies, with close supervision, gives better results than routine induction of labor at 42 wk. The importance of the pelvic score as an indication for induction is stressed. A protocol has been developed which can be used in cases of uncertain dates as well.