ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Current literature on definition, metastatic potential, and treatment of microinvasive squamous cell carcinoma of the vulva is reviewed. There is marked disparity among the various reports about the features of this lesion that are most crucial in predicting the propensity to recur or metastasize. Nonuniformity of the techniques for measuring stromal invasion is noted among many of them as well. The issue of conservative versus more aggressive surgical treatment of microinvasive squamous cell carcinoma of the vulva is discussed within the context of the reviewed data. One should exercise prudence in determining which affected patients are appropriate candidates for conservative surgical therapy.

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The exaggerated physiological adaptation to pregnancy in women bearing twins is exemplifed by the increased plasma volume in both primigravidas and multiparas, as compared to singleton pregnancies. There is a significant relationship between birth weight and plasma volume in both primigravid and multiparous singleton pregnancies and in multiparous twin pregnancies but not in primigravid twin pregnancies. This paper considers the relative importance of plasma volume expansion, maternal nutrition (particularly zinc), and birth weight in twin pregnancies. One hundred seventeen primigravid twin pregnancies with deliveries after 37 weeks of gestation were studied.The pregnancies were divided into three groups: those in which the mothers were normotensive, those in which they had mild preeclampsia, and those in which they developed proteinuric preeclampsia. There was a significant relationship between plasma volume and birth weight in primigravid twins whose mothers had mild preeclampsia. In primigravid twins whose mothers were normotensive, the association was almost identical with that in multiparous twin pregnancies, but, on account of the greater scatter of values, the correlation coefficient was not significant at 0.29. There was no positive relationship between plasma volume and birth weight in twins whose mothers had proteinuric preeclampsia. The results from twins of normotensive mothers and those whose mothers had mild preeclampsia were combined. There was a significant relationship between plasma volume and the combined birth weights of twins born after 37 weeks of gestation to primigravidas.The 117 primigravid twin pregnancies were divided according to presence or absence of preeclampsia and allocated to the appropriate birth weight centile categories (Table 1). In the total group, there was an over-representation of those under the 25th centile, with fewer in the intermediate categories. In those who were normotensive, 40 per cent were under the 25th centile, but in those with mild preeclampsia there was over-representation in the intermediate category (50th to 75th centile; 36 per cent). In proteinuric preeclampsia, as expected, nearly 47 per cent were under the 25th centile birth weight. When twins of normotensive pregnancies and those of mildly preec-lamptic pregnancies were grouped together, there was still a greater than expected proportion over the 25th centile (35 per cent).

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The uterine arteries undergo considerable structural changes during pregnancy. In some abnormal pregnancies, i.e., those associated with hypertension and/or untra-uterine growth retardation. ischemic lesions of the placenta are prominent indicating a reduction in maternal utero-placental blood flow. The present authors have made a

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The incidence of congenital malformations is about three times higher in infants of insulin-dependent diabetic mothers than in the general population. The exact cause of this increase is not known, but experimental and clinical data show an association between congenital malformations and maternal hyperglycemia in early pregnancy, the critical period with regard to fetal malformations.The present authors report an association between the severity of maternal hyperglycemia in early pregnancy, as measured by blood hemoglobin A1cvalues, and the occurrence of fetal malformations in mothers with insulin-dependent diabetes. Between April 1978 and December 1982, the maternal hemoglobin A1cvalues had been determined at least once before the end of the 15th week of gestation in 139 insulin-dependent diabetic patients who gave birth after 24 weeks of gestation. In addition, a fetal malformation was observed in each of three cases of induced abortion in which early hemoglobin A1cdeterminations had been carried out. Pregnancies were classified as 1) not complicated by malformation, 2) complicated by minor malformation, and 3) complicated by major malformation. A malformation was classified as major if it was fatal or likely to cause serious handicap to the child. Other malformations were classified as minor.A total of 125 pregnancies were not complicated by fetal malformation. A malformed fetus or infant was observed in each of 17 pregnancies. In six cases, the anomalies were classified as minor, and in 11 cases they were classified as major. The mean initial hemoglobin A1cvalue was significantly higher in the group with minor malformations (9.3 per cent, with an SD of 1.9 per cent) and in the group with major malformations (9.6 per cent; SD, 1.8 per cent) than in the group without malformations (8.0 per cent; SD, 1.4 per cent) (P < 0.05 and P < 0.001, respectively). The difference in hemoglobin A1cvalues between the groups with minor and major malformations was not significant. In all of the 17 pregnancies complicated by malformation, the mean initial hemoglobin A1cvalue was 9.5 per cent (SD, 1.8 per cent), which was significantly higher (P < 0.001) than in the group without malformation. There was a significant positive relationship (x2= 11.9; P = 0.001) between the maternal hemoglobin A1cvalue in early pregnancy and the occurrence of malformation. An initial hemoglobin A1cvalue of 10.0 per cent or more was associated with malformations in six of 17 pregnancies (35.3 per cent). Two of these were minor (11.8 per cent) and four were major (23.5 per cent) malformations. An intermediate hemoglobin Alcvalue (8.0–9.9 per cent) was associated with malformations in eight of 62 pregnancies (12.9 per cent). Relatively low initial hemoglobin A1cvalues, i.e., below 8.0 per cent, were associated with malformations in only three of 63 pregnancies (4.8 per cent).

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The present authors report an evaluation of ultrasound screening offered to pregnant women as a supplement to standard antenatal care. The expected benefits were: earlier diagnosis and improved management of multiple pregnancies; improved estimating of date of confinement and thereby a reduction of “false” postterm inductions of labor; and improved surveillance of intrauterine growth, with earlier diagnosis and treatment of intrauterine growth retardation and consequent reduced morbidity and mortality of newborn babies.The women, 1009 in number. were allocated in random fashion to one of two groups: 510 ultrasound cases and 499 unscreened controls. The ultrasound group was offered ultrasonographic examinations in the 19th and 32nd weeks of gestation. The two groups were comparable with regard to maternal age, education, marital status, and other characteristics.The proportions of spontaneous abortions did not differ significantly between the screened and unscreened groups (13 and 19, respectively), and there were no major differences in the occurrence of complications such as preeclampsia (33 vs. 26), anemia (34 vs. 26), and urinary tract infections (62 vs. 52). There were fewer third trimester hemorrhages (spontaneous abortions excluded) among the unscreened women, but this difference was not significant.Although the amount of sick leave taken during pregnancy was equally distributed in the two groups, averaging 1.43 weeks per pregnancy among the screened and 1.33 among the unscreened women. a significantly higher pro

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Women with asymptomatic shedding of herpes simplex virus are at risk for transmitting the virus to their newborns. Shedding of herpes simplex virus from the cervix, in the absence of clinical signs and symptoms. has been shown to occur in from 0.09 to 4 per cent of pregnant women. The risk of infection in infants vaginally delivered of mothers with asymptomatic shedding is not known.The present study was designed to determine the risk

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The incidence of amniotic fluid emboli is estimated at one in 8,000 to one in 80,000 deliveries. The risk factors for embolization, determined retrospectively, are maternal age (>32 years) and multiparity. Intrauterine contraceptive devices and other factors have been implicated, but there is no proven association.The present authors describe a patient with embolization whose condition was extremely poor before she received cryoprecipitate therapy. This was administered in an effort to reverse the impending disseminated intravascular coagulation and adult respiratory distress syndrome.The patient, a 27-year-old white woman (gravida 2, para 0, abortus 1), was admitted on June 19, 1980, with the complaints of rapid weight gain and recent onset of pedal edema over the previous 3 weeks. Physical examination was remarkable for a blood pressure of 40/90 mm Hg, a heart rate of 110 beats per minute, a markedly enlarged (for dates) uterus, 1 to 2+ pitting edema of the lower extremities to the knees, and brisk deep tendon reflexes that were equal and without clonus. Examination of the cervix showed it to be 1 to 2 cm dilated and 50 per cent effaced, with the vertex in −2 position. Fetal heart tones were noted, and rate and rhythm were regular. Pertinent laboratory data included: hematocrit, 32.4 per cent; fibrinogen, 550 mg/dl; platelet count, 426,000/mm2; prothrombin time, 13.7 seconds; lactic dehydrogenase, 393 lU/liter (control, 90–210); alkaline phosphatase, 249 lU/liter (control, 25–75); creatinine, 1.8 mg/dl; Wood urea nitrogen, 29 mg/dl; and bilirubin, 0.8 mg/dl. Urinalysis disclosed no proteinuria, red blood cells, or casts. Utrasonography of the pelvis revealed a mass attached to the fetus, and a tentative (later confirmed) diagnosis of sacrococcygeal

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

With recent improvements on obstetrical ultrasound, abnormal enlargement of the human fetal cerebral ventricles (ventriculomegaly) is being detected more frequently. Several problems, however, remain unsolved. The relationship between ventriculomegaly detectedin uteroand hydrocephalus (communicating and noncommunicating), detected in the neonatal period, is only speculative. Another problem is the accuracy of prenatal ultrasound in distinguishing hydrocephalus from ventricular enlargement associated with other brain malformations. Finally, there is the question of how confidently other congenital malformations can be excluded.The present authors evaluated the prenatal management and neonatal outcome in 24 fetuses with ventriculomegaly, reviewing the serial obstetrical sonograms of these fetuses to assess the ability of ultrasound to detect normal and abnormal fetal ventricular development at different gestational ages. They correlated the prenatal and postnatal histories of the fetus with ventriculomegaly to see how serial ultrasound findings can be used to select a therapeutic strategy that offers the best hope for improving outcome and prognosis of the salvageable fetus and avoids unnecessary intervention when the outlook is hopeless. It appears that most fetuses with ventriculomegaly do not require interventionin utero.The 24 cases were divided retrospectively into three categories: 1) ventriculomegaly associated with other severe anomalies thought to be incompatible with life (10 cases): 2) ventriculomegaly detected fortuitously late in gestation (three cases); and 3) isolated ventriculomegaly, without detectable associated lethal anomalies (11 cases).In cases of ventriculomegaly with severe associated anomalies, most families requested termination of pregnancy, and vaginal delivery was induced. Three cases required ultrasound-guided transabdominal cephalocen-tesis to prevent dystocia. Eight fetuses were stillborn, and one survived for approximately 24 hours. In the three fetuses found during ultrasound examination for obstetrical indications near term, the extent of the ventriculomegaly or associated anomalies was so severe that obstetrical management was biased to decrease maternal morbidity at the expense of the fetus. Two fetuses were stillborn, and one survived for only 30 minutes.In 10 of the 11 fetuses with isolated ventriculomegaly, serial ultrasound showed stable ventriculomegaly without significant enlargement of the ventricles or of the head with advancing gestation. Ten of these babies survived. Only three of the survivors had signs of increased intracranial pressure at birth and required ventriculoperitoneal shunts in the first 2 weeks of life. Only one of these had obstructive hydrocephalus secondary to aqueductal stenosis. Two of the seven survivors who showed no evidence of increased intracranial pressure at birth subsequently developed signs of increased pressure and of progressive ventricular enlargement. Ventriculoperitoneal shunts were placed in these at 2 and 3 months of age, respectively.Only one fetus showed mild progresive ventricular en-

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Fetus in fetu is a rare congenital abnormality that results from embryonic duplication. The distinction between this phenomenon and teratoma is determined largely by whether an axial skeletal system exists. The present authors describe a case of fetus in fetu in this report.A Korean boy, aged 8 weeks, was admitted to the hospital because of a progressive abdominal distention. His birth weight was 4 kg, and he was delivered by cesarean section. At the time of admission, physical examination revealed a large cystic mass filling nearly all of the abdominal cavity. A simple radiograph of the abdomen showed the densities of femur, tibia, and pelvic bones. The results of routine laboratory examinations were within normal limits. Upon operation the cystic mass, originating in the upper retroperitoneum, was found to displace the stomach and transverse colon upward, and loops of small intestine toward the pelvic cavity. To facilitate removal, approximately 2 liters of serous straw-colored fluid were aspirated through a semitranslucent membrane covering the mass. The tumor mass consisted of two parts that were floating inside the cyst. The cystic membrane was easily separated from the surrounding organs except for an area where the superior mesenteric artery was feeding the two masses through a slender cord. The mass was removed entirely.The mass weighed 650 gm and was enveloped by a semitranslucent amnion-like membrane that stretched out to the umbilical cord of the “fetus.” The membrane was lined, microscopically, by amnion and metaplastic squamous epithelium, resting on fibrocollagenous tissue. The included fetus consisted of two masses connected by a thin membrane. A small vessel was found inside the membrane.Of the two masses, the one with an umbilical cord, designated as “A,” had features of an acardius acephalus. The structures of the lower half of the body, consisting of a protruded umbilicus, two lower extremities, pelvic bones, and vertebrae, were seen. The entire mass was covered by edematous skin. The skeletal system of the extremities was complete, including normally formed joints.The connecting stalk, resembling an umbilical cord, was lined with attenuated stratified squamous epithelium. The cord epithelium was continuous with that of amniotic membrane that covered the mass. This stalk contained several loops of bowel. Sections from the bowel loops showed various types of mucosa, such as jejunum, ileum, and colon. Between circular and longitudinal layers of smooth muscle, an adequate number of myenteric plexus with ganglion cells was found. Serosa were clearly visible, though the mesentery was not observed.The vertebra, above the two lower extremities, was composed of a column of segmented cartilages and trabecular bones. Bone marrow showed active hematopoiesis. Beside the vertebra, several sympathetic ganglia and a large trunk of peripheral nerve, probably sciatic, was found. A small cystic dilatation of the upper dorsal portion of the mass was seen and appeared to be a meningocele. A “pelvic cavity” was composed largely of mature fat, skeletal muscle, and fibrocollagenous tissue. Two adrenal glands and two testes were identified. The adrenal cones showed a pattern of permanent cortex with prominent zona fasciculata, and the medulla consisted of a few nests of chromaffin cells around vessels. The testes were well developed, corresponding in histology to those of early infancy.The “B” mass, connected with “A” by a thin membrane originating in the vicinity of the umbilical cord, was tabulated irregularly. Externally, mass “B” had the appearance of an acardius amorphus. It was covered partly by hairy skin and consisted of cerebrum and choroid plexus above an irregular bony mass resembling skull base. Retinal pigments, paranasal sinuses, salivary glands, thyroid, parathyroid, pancreas, lymph nodes, and trachea were found also. The cerebral tissue was covered by scalp and meninges but not by calvarium. The brain showed partial but definite cortical development and had rich vasculature. Six-layered cortex and white matter were clearly visible. The ventricular system, however, was not seen. The salivary and thyroid glands were of fetal type. The trachea had cartilage rings and mucus glands. No pulmonary tissue was present. The pancreas showed numerous acini, islands of Langerhans. and dilated intercalate ducts. No sign of the heart, liver. spleen, or upper gastrointestinal tract was found. Since the specimen was fixed in formalin immediately, a chromosome study of the mass could not be performed.The patient (host) did very well postoperatively. At the time of this report. he is healthy and without evidence of disease.

ISSN:0029-7828    

出版商:OVID    

年代:1985

数据来源: OVID