Biomedical subjects
Publications and source records attributed to R Toaff.
Four cases of communicating uteri, representing two previously unreported types, are presented. Forty-nine reported cases of communicating uteri are reviewed and reclassified into nine types. Clinical and embryologic aspects are discussed.
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In a prospective study of 231 breech presentations in primigravidae at term 260 (81 per cent) were delivered vaginally with no perinatal mortality. A single case of fetal injury (Erb's palsy) was recorded and only one infant had an Apgar score of under 7 at 5 minutes. In 17 patients selected for vaginal delivery, caesarean section was necessary for abnormal uterine activity, prolapse of the umbilical cord of fetal distress. Elective caesarean section wad performed if routine x-ray pelvimetry showed values below defined limits at the brim, midcavity, or outlet or if the fetal head was extended.
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This study compares perinatal results of 7,604 deliveries in two successive years (1976--1977) in which no policy changes occurred other than a four-fold increase in electronic intrapartum monitoring. In the first year 15.4 per cent of births were monitored selectively. In the second year all births were monitored, with the exception of patients admitted at an advanced stage of labor and elective cesarean section. The results show no significant improvement either in intrapartum or in early neonatal mortality rates. The same results obtained in cesarean section rate and in instrumental deliveries. The only positive result is a significant reduction of low Apgar scores in the unselected monitoring group (1977). The low morbidity is considered to be a result not only of increased monitoring, but also of active management of labor, of a short duration of labor and of intensive neonatal care.
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Thirteen nephrosclerotic women were followed for 2 to 7 years from the time a diagnosis was made following a pregnancy complicated by hypertension. Ten patients developed sustained hypertension. Twelve women who were examined responded with a hypertensive pattern to acute salt load. Of the 10 patients who were examined, seven had a reduced renal plasma flow (RPF) demonstrated by the phenolsulfonphthalein (PSP) excretion test. The present observations support the view that the vascular lesion in the kidneys precedes and persists independently of pregnancy. The pregnant state brings the hypertensive disease to clinical expression.
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A live 22-week-old cyclops fetus with a 69 XYY chromosome pattern and partial hydatidiform mole of the placenta is reported. Although cyclopia and chromosomal triploidy have certain features in common they appear to be two quite distinct entities. As no other 69 XYY fetus has survived to 22 weeks gestation and no other case of cyclopia has been reported with a triploid set of chromosomes, the assumption that the two conditions occurred coincidently in this fetus will have to await the accumulation of additional case reports.
In the course of an investigation of 60 patients with clomiphene-resistant anovulation, 35 cases of androgenic hyperacitvity were detected. Fractionation of urinary 17-ketosteroids (17-KS) by a rapid method of chromatography proved to be both practical and reliable for the detection and classification of androgenic disorders of adrenal, ovarian, or mixed origin. In contrast to the total 17-KS values, the fractionated 17-KS values were elevated in all but one of these cases. Following dexamethasone suppression, individual 17-KS showed significant decreases in both adrenal and mixed adrenal-ovarian cases, in contrast to ovarian cases in which no significant change was detected. Human chorionic gonadotropin (HCG) stimulation combined with dexamethasone suppression did not cause any significant change in individual 17-KS values in the adrenal group, whereas both the mixed adrenal-ovarian and ovarian cases showed significant increases. Of 34 treated patients, 22 conceived, 21 had normal deliveries, and 1 aborted. Twelve became ovulatory. Eleven patients were treated with dexamethasone, nineteen with combined dexamethasone and clomiphene, two with dexamethasone and HCG, and two with HCG only.
Traumatic damage to the endometrium (corporeal adhesions) and/or to the cervical internal os (cervical stenosis or atresia) may cause hypomenorrhea-amenorrhea, the only sign of Asherman's syndrome. We demonstrated a close correlation between severity of menstrual insufficiency and extent of corporeal adhesions. Minor adhesions in the lower part of the uterine cavity, however, may cause severe hypomenorrhea, frequently complicated by dysmenorrhea. Secondary amenorrhea may be due either to complete obliteration of the uterine cavity or to stenosis or atresia of the internal os, as proved by radiologic studies. When amenorrhea is due to stenosis or atresia of the internal os, the ovarian cycle continues but the endometrium becomes refractory to horomonal stimuli, and hematometra does not occur. Simple cervical dilatation restores menstruation within 4 to 5 weeks. The menstrual insufficiency of Asherman's syndrome, therefore, may be explained by two pathophysiology mechanisms: (1) reduction of the endometrial bleeding area and (2) trophic changes and unresponsiveness of the endometrium, perhaps caused by a visceral reflex originating in the area of the internal os.
In addition to membrane rupture, pharmacological doses of oxytocin (2.6 mU/minute rusing stepwise to 422.4 mU/minute) were used in 134 patients and the results compared to those obtained in 144 patients given only physiological doses of oxytocin (2.6 to 13.2 mU/minute). Pharmacological doses of oxytocin gave better results in terms of induction-delivery intervals, incidence of failed inductions and puerperal morbidity. The incidence of hypertonus was similar in both groups and unrelated to oxytocin doses. A uterine activity of 276 Montevideo units, modified to 200 to 220 Montevideo units for grande multiparae, is defined as the goal of oxytocin treatment in induction of labour. A sign of imminent uterine tetany in the intrauterine pressure curve (the 'damping sign') is described.