Biomedical subjects
Publications and source records attributed to T H Lippert.
A 23 year old, gravida O, conceived 18 months following insertion of a copper containing IUD. At 10 weeks; gestation the IUD was removed. At 42 weeks' gestation, an infant was delivered normally, with severe upper limb reduction deformities and other minor malformations. However, reviewing the literature the possible role of the IUD in the etiology of limb reduction deformities cannot be supported.
The prostaglandin E2 derivative Sulprostone was used in the management of intrauterine fetal death and in therapeutic abortion in advanced pregnancy. While with extraamniotic administration there was a success rate of 50% after 24 hours, the rate of success was 86% after intramuscular administration. A cervix-ripening effect was not always observed by means of intracervical injection of Sulprostone. Such pre-treatment of the cervix did not improve the induction-abortion time after intramuscular administration of Sulprostone. Side effects were only slight following Sulprostone.
Uterine hyperactivity can be treated with uterine relaxants. In order to establish the most satisfactory dosage for Fenoterol, several doses were administered intravenously to pregnant women during birth and the actions on uterine relaxation and on side effects were examined. Saline was injected in a group of patients as control. With doses of 20 and 40 micrograms Fenoterol, submaximal uterine relaxation times of 7.3 and 7.9 min were obtained. Subjective side effects were observed, such as palpitations and restlessness; maternal blood pressure was unchanged. The pulse rate increased significantly only after 40 micrograms. 10 micrograms Fenoterol induced a uterine relaxation time of 5.6 min, was without side effects and was therefore regarded as the most satisfactory dosage. With 5 micrograms Fenoterol a relaxation time of only 3.2 min was observed. In the control group, administration of saline was without any observable effect.
The action of the uterine relaxant ritodrine on placental, myometrial and cardiac blood pools has been examined during spontaneous and oxytocin-induced uterine activity. 113mIndium was injected intravenously and the blood pools were measured by recording gamma-activity externally. After i.v. injection of Ritodrine, the typical blood pool changes in labor were inhibited. Thereafter, placental and myometrial blood pools increased more than due to inhibition of labor alone. Simultaneously, there was a corresponding decrease in cardiac blood pool indicating an increase in cardiac output. The rapid inflow of blood in the uteroplacental region after Ritodrine indicates an improved hemodynamic situation. This action could be of benefit in emergency situations in a hyperactive ischaemic uterus during labor.
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The use of prostaglandin gel for therapeutic termination of second trimester pregnancy, the management of intrauterine fetal death, ripening of the cervix and induction of labour is reviewed. For these indications, prostaglandin gel is acceptable to patients, effective, and has low incidence of side effects and complications.
The action of buphenin, a uterine relaxant from the group of adrenergic beta-mimetics, was examined on the blood pools of placenta, myometrium and heart, in 10 pregnant women. The method consisted of an i.v. injection of the radioisotope 113m-Indium and of registering the blood pools by external measurement of the gamma-activity. buphenin caused an increase in placental and myometrial blood pools with a corresponding decrease in cardiac blood pool. These changes were observed in all the cases examined and occurred whether the uterus had previously been inactive or in labour. The changes in blood pool were dependent on the dose of buphenin administered but there was no relationship apparent between the degree of pool changes and severity of pregnancy complication prevailing.
Directions are given concerning the medical procedure in cases of rape. Besides emergency treatment for serious injury the patient should have her legal rights explained as well as the procedure for the forthcoming examination. A case history with special attention to the present case of rape is obtained. During the examination special attention is paid to the obtaining of evidence which wll stand up in a court of law. The taking of suitable samples is explained. The available methods for tracing sperm sources are described. Finally the treatment of after effects of rape is discussed.
Since the causes of toxemia of pregnancy are unknown, therapy is still symptomatic and is now determined by the most recent knowledge of the pathophysiology of the disease. Rest, a balanced, predominantly protein-rich diet and avoidance of stress are recommended as prophylactic treatment of toxemia of pregnancy in patients with a predisposition of the condition. Early recognition of the symptoms of toxemia of pregnancy is of great importance. Treatment of mild cases consists of bed rest, possibly supplemented by sedatives and a preponderantly proteinrich diet. Administration of diuretics is obsolete and sodium restriction is no longer recommended. Antihypertensives are seldom indicated. Overweight women are no longer maintained on specially low calorie diets. Severe cases of toxemia of pregnancy must be trated as inpatients under intensive care. Principles of treatment are: 1. Prevention of seizures (by sedation). 2. Improvement of the general condition of the women (especially circulation and renal function). 3. Delivery at an opportune time for mother and child. Treatment of eclampsia follows largely the same principles. In these cases, immediate delivery is required regardless of the condition of the fetus.
In twelve cases of intrauterine fetal death labour was induced by combined treatment with an intra-cervical balloon and oxytocin infusion. The average induction-delivery time was approximately 11 hours. Acceptance of this method for induction of labour by the patients was satisfactory and the side effects were minor.
The action of 2,6-bis(diethanolamino)-4,8-dipiperidinopyrimido-(5,4-d)pyrimidine (dipyridamole, Persantin) on utero-placental and cardiac blood pool dynamics was examined in 12 pregnant women. 113mIndium was injected i.v. and blood pool changes in the heart, placenta and myometrium were registered by external measurement of the gamma-activity. While there was a significant decrease in blood pool of the heart after dipyridamole, there were no marked changes in the blood pools of placenta or myometrium. The decrease in cardiac blood pool was interpreted as a sign of an increase in the cardiac output.
The prostaglandin E2 derivative, Sulproston, was administered extra-amniotically for the induction of abortion in an average dosage of 200 microgram, in ten patients. With a success rate of 50%, the subjective side effects were very slight. Temperature, pulse rate, blood pressure and frequently of breathing did not change markedly. The ADP- and collagen-induced platelet aggregation showed a tendency to increase but disaggregation remained the same. Spontaneous platelet aggregation according to Breddin did not change. The parameters examined of the coagulation and fibrinolytic system showed only a slight increase in fibrinolytic activity during and after induction of abortion. The remaining hematological parameters showed no changes.
In established intrauterine fetal death, 20 patients were treated with prostaglandin E2 gel administered extraamniotically. The results were compared with those of another group of 20 patients who had received combined treatment. In this group, one or more of the following agents had been administered :- i.v. oxytocin, 20% NaCl solution or Premarin instilled intraamniotically, introduction of a balloon catheter or Rivanol administered extraamniotically. Average induction-abortion interval for the PG group was about 12 hours while for the second group it was about 30 hours. The side effects observed were slight in both groups. The results show that administration of PG-gel can be used with advantage in fetal demise because of the relatively short induction-abortion intervals obtained, the insignificant side effects and the low dose of PG required.
The present survey deals with the physiological development and pathological disturbances of the female genital organs in childhood. The different phases in development of the female genitals are discussed under sections on the newborn phase, the resting phase and the maturing time. Then follows a description of the most important illnesses met with in practice including various types of vulvovaginitis, tumours, genital bleeding and accidental injuries. This review could not be extended to include a description of congenital malformations and endocrinological disturbances.
In the present work, an attempt has been made to verify whether Complamin improves placental circulation as suggested by several authors. Complamin was administered intravenously to patients in the last trimester of pregnancy and its action on blood pool dynamics was examined over 30 min. The results from 30 investigations showed that a significant reduction in uteroplacental blood pool occurred. The production of placental hypovolaemia, which led to a reduction in blood pool of more than 30% in some cases, is regarded as a potential danger to the fetus.
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Up to the present time, the most extensive knowledge in prostaglandin research has been achieved in the field of reproductive physiology. It seems now certain that prostaglandins are involved in each phase of the reproductive process although their precise physiological functions cannot yet be completely explained. For example they are thought to play an important role in the hypothalamic -- pituitary system in the liberation of LHRH and in the ovary in steroid genesis, ovulation and luteolysis; also, in the non-pregnant uterus in the onset of menstruation while at conception both sperm and ovum transport are influenced by prostaglandins. In pregnancy, a prostaglandin function has been demonstrated in the uterus in initiating labour in cases of abortion and in birth at term. Further, they appear to be involved in regulating the blood circulation in placenta, cord and fetus. Already, because of their established physiological functions, the prostaglandins have been introduced successfully into clinical use.