[Coelioscopy in Stein-Leventhal syndrome].
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Biomedical subjects
Publications and source records attributed to M Mintz.
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A randomly selected sample of 252 infants aged 5--18 months was evaluated through medical and developmental examinations. Developmental achievement scores and factors such as management of delivery and fetal distress were studied in relation to Apgar scores. Low-Apgar-score infants aged 5--8 months achieved consistently lower scores on all developmental fields. High-Apgar-score infants at younger and older ages did not differ on their achievement scores. Low Apgar score was much more frequent in infants delivered by vacuum extraction than in those delivered spontaneously, with forceps or by cesarian section. The frequency of low Apgar score was higher when fetal distress occurred.
The synthetic steroid amidine 3-alpha-hydroxy-16-imino-5-beta-17aza androstan-11-one (R 5135) is known to elicit long-lasting spiking in the cortex in the presence of neocortical damage. R 5135 administered to amygdaloid-kindled and naive rats resulted in regular, high-amplitude spiking in the cortex but only occasionally elicited small-amplitude spikes in the amygdala (AMY) and hippocampus (HPC). Interictal spikes from the AMY of kindled rats were not synchronized with cortical spikes induced by the steroid. Given that R 5135 is known to be a GABAA receptor antagonist, these findings suggest that GABAA receptors in AMY and HPC may have lower affinity for 3 alpha-hydroxysteroids.
Three patients with known or subsequently proven sarcoidosis had CT of the retroperitoneum because of clinical symptoms referable to this area. Gross splenomegaly was evident in all cases. The liver was massively enlarged in one patient and normal size in two patients. Lymphadenopathy was present in many nodal groups.
The author having learned the true character and the value for teaching of his own complications set out a questionnaire which would draw a line distinguishing between complications that seemed in retrospect to have been inevitable and those that could be attributed to the inexperience or lack of care of the operator. The analysis of 194 severe complications occurring in 100,000 laparoscopies performed over 20 years includes 53 cardio-respiratory complications, of which 15 were fatal, 122 injuries or burns due to the instrument, of which 4 were fatal and 18 different complications. No statistical conclusions can be drawn because the figures are approximate and probably below the true levels. But a calculated comparison of the risks can be significant, so long as one avoids mixing up the operators who are well trained, careful and personnally responsible for their actions with those who work hurriedly without proper estimation of the difficulties and dangers. Most opinions agree that apart from the risk of embolus and of general anaesthesia there is no risk of a fatal complication due to laparoscopy. This is particularly true of cardio-respiratory complications, which can be avoided if empirically proven prophylactic measures are taken which take into account the various theories of the aetiology and pathology, which are still being studies. From the results of this enquiry it emerges that certain criteria of care have to be followed which are too often neglected, but they should be applied systematically even when they appear to be unnecessary.
Indications for per-laparoscopic ovarian biopsy has decreased significantly during the last two decades, thanks to the progress in hormone assays and new drugs. Despite this, there is still place for ovarian biopsy in the following circumstances: in the rare cases of amenorrhea with high levels of FSH and LH, the value of biopsy is important for distinguishing between early menopause and gonadotropin-resistant ovaries; it allows the clinician to refrain from or to increase his therapy; in the few cases of Stein-Leventhal or borderline syndromes, there is a place for laparoscopic biopsy after failure of hormonal treatment, if only to avoid post-laparotomy adhesions. The greatest value is in infertility, because of the frequency of ovarian factors and the success rate of laparoscopy coupled with ovarian biopsy.
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