摘要:

From 1966-1982, 138 previously untreated patients with metastatic malignant gestational trophoblastic disease received primary chemotherapy at the Southeastern Regional Trophoblastic Disease Center. Fifty-six (41%) had poorprognosis metastatic gestational trophoblastic disease, and 51 (91%) of these patients were initially treated with multiagent chemotherapy. Sustained remissions were achieved in 128 patients (93%). Patients who had metastatic involvement of more than one anatomic site, disease duration of greater than four months, antecedent nonmolar pregnancy, or dinicopathologic diagnosis of choriocarcinoma were at significantly increased risk for failure to achieve sustained remission compared with patients who lacked these clinical features. Initial human chorionic gonadotropin level and site of metastasis had no significant effect on survival in these previously untreated patients. Patients with disease duration of greater than four months who. had an antecedent nonmolar pregnancy were at significantly increased risk, with only 12 of 20 (60%) surviving, versus all of 85 patients with short duration of disease and antecedent molar pregnancy, and 32 (94%) of 34 patients with other combinations of these factors (P<.001). Initial therapy for patients with metastatic gestational trophoblastic disease should be selected on the basis of prognostic factors that predict a high probability of failure with single-agent chemotherapy alone. Patients with prolonged duration of disease and nonmolar antecedent gestation are at high risk for failure using traditional forms of methotrexate and actinomycin D-based combination chemotherapy.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Neoadjuvant chemotherapy with cisplatin, bleomycin, and methotrexate was used in the primary treatment of 33 consecutive patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stages IB-HI; tumor volume greater than 4 cm). This therapy induced responses in 25 of the 33 patients (four complete, 21 partial; overall 75.7%), thus permitting radical surgery in all these cases despite initial bulky tumor. Surgery consisted of type HI-IV radical hysterectomy plus systematic para-aortic and pelvic lymphadenectomy. The average number of lymph nodes removed was 63 (range 37-117). At histologic examination, complete responses were found in four cases (12.1%) and partial responses in 14 cases (42.4%). The highest response rates were found for vaginal disease (80%), followed by cervical disease (72%) and parametrial disease (63.1%). A lower than expected incidence of lymph node metastases was detected (16%, four of 25). Chemotherapy did not seem to complicate surgery in these circumstances. The combination of cisplatin, bleomycin, and methotrexate chemotherapy and surgery did not produce severe morbidity. However, chemotherapy-induced nausea and vomiting and moderate postoperative complications did occur. These encouraging preliminary results need a longer follow-up to evaluate the influence of treatment on disease-free survival.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine the impact of routine naso-oropharyngeal DeLee and tracheal suction on the prevention of meconium aspiration syndrome, we compared 755 infants with meconium-stained fluid, born during a 12-month period (1983), with a similar group of 742 infants born in a previous year (1975) when these suctioning techniques were not routinely used. Morbidity and mortality data from meconium aspiration syndrome in 103 infants, using combined DeLee and tracheal suction during a five-year period (1979-1983), were also analyzed retrospectively. In spite of a combined DeLee and tracheal approach toward the prevention of meconium aspiration, the rate of meconium aspiration syndrome (2%) was not different in 1975 and 1983. Timing of obstetric DeLee suction (whether before or after delivery of the chest) did not influence the presence of meconium below the vocal cords (37 versus 36%, respectively). Even though significant morbidity remained associated with meconium aspiration in both periods studied, a drastic reduction occurred in neonatal mortality, from 46% in 1975 to 12.5% in 1983, which was probably aided by major advances in perinatal care and supports routine prophylactic suctioning of meconium at birth. From these findings, we suggest that meconium aspiration syndrome is predominantly an intrauterine event secondary to fetal distress, and that DeLee and tracheal suctioning reduce only its severity.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Continuous oxygen saturation measurements were obtained in 103 pregnant patients and 96 of their newborns by a pulse oximeter during the peripartum period. The parturients received narcotic sedation; epidural, spinal, or general anesthesia; or no analgesia. Seventy-nine patients had oxygen saturation levels over 90% (mean 97.6%), and 24 had one or more oxygen saturation levels less than or equal to 90% (mean 95.6%,P=.001). For all neonates, the mean oxygen saturation was in the “hypoxic range” at one minute (77.6 ± 11.48%), five minutes (84.4 ± 7.64%), and ten minutes (89.4 ± 6.29%). More desaturation episodes were noted in mothers exposed to a central nervous system depressant (P=.041). When mothers with and without desaturation events were compared, no differences were found for age, parity, race, hematocrit, smoking, hypotensive episodes, or delivery route. More maternal desaturation episodes occurred during transport (P=.0016) and while in the recovery room (P=.0003) than in other study periods. Maternal peripartum desaturation events occurred without adverse neonatal effect when prompt treatment was provided. Neonatal hemoglobin oxygen saturation less than or equal to 90% is commonly found within ten minutes after birth and does not always merit the designation of “hypoxia.”

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We evaluated the effect of birth order on the incidence and severity of intraventricular hemorrhage in 29 sets of very low birth weight twins (1500 g or less). Intraventricular hemorrhage occurred in 55% of first-presenting twins and 62% of second-presenting twins. The incidence of minor intraventricular hemorrhage (grades I and II) was 41% for first twins and 52% for second twins, whereas the incidence of major intraventricular hemorrhage (grades III and IV) was 14 and 10%, respectively. None of these differences reached statistical significance. We conclude that birth order does not appear to have a major effect on the incidence or severity of intraventricular hemorrhage in very low birth weight twins.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cardiac events in 30 patients in preterm labor on ritodrine therapy were examined continuously on a Holter monitor. Unsuspected events, such as persistent severe tachycardia, premature ventricular contractions, and supraventricular premature contractions, were observed. These events did not occur more frequently in patients with cardiac symptoms. None of these changes were observed by standard monitoring methods. Continued beta-mimetic stimulation in the presence of these events may lead to the serious cardiopulmonary complications that have been reported during ritodrine infusion.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Three hundred thirty-seven high-risk pregnancies were screened using a modified biophysical profile consisting of nonstress testing (NST) and ultrasound evaluation of amniotic fluid volume. Ultrasound assessment of fetal breathing and body movements was performed only to evaluate the nonreactive NST. Decreased amniotic fluid volume and spontaneous fetal heart rate (FHR) decelerations were considered abnormal findings during antenatal testing, and served as indications for delivery regardless of FHR reactivity. Despite intervention, decreased amniotic fluid volume and spontaneous decelerations were associated with an increased incidence of meconium staining, decelerations during labor, cesarean section for fetal distress, and small for gestational age infants. Perinatal morbidity also occurred in patients with spontaneous decelerations and normal amniotic fluid volume. The search for spontaneous FHR decelerations by electronic fetal monitoring should continue during antepartum testing because FHR decelerations cannot be identified by conventional ultrasound assessment. The modified profile seems practical for routine assessment of fetal well-being in high-risk pregnancy, and affords insights unavailable with ultrasound surveillance alone.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fetal lung maturity can be predicted by the technique of fluorescence polarization using fluorescent phosphatidylcholine instead of diphenylhexatriene. To further elucidate the mechanism of this assay, we used high-speed centrifugation to isolate amniotic fluid lamellar bodies. Each of 75 amniotic fluid samples was separated into two fractions: a lamellar body pellet and a lamellar body-free supernatant fluid. Amniotic fluid and these fractions were assessed in a fluorescence polarization assay using a fluorescent phosphatidylcholine. Regardless of the maturity of the fetal lung, the lamellar body fractions had low polarization values (0.127-0.216), whereas the lamellar body-free fractions had high polarization values (0.266-0.344). Compared with the polarization of amniotic fluid, the fluorescence intensity of the lamellar body fractions had a strong inverse correlation (r=-0.871). The polarization of lamellar body pellets was not linearly related to the polarization of amniotic fluids. These findings do not support the theory that this fluorescence polarization assay measures the microviscosity of surfactant lipids. Instead, we propose that this assay indicates the quantity of surfactant relative to the quantity of nonsurfactant receptors of fluorescent phosphatidylcholine in amniotic fluid.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To assess the degree of perinatal regionalization, maternal and infant records were reviewed for all very low birth weight (501-1500 g) infants born in calendar years 1985-1986 to residents of the primarily rural North Central Perinatal Region of Illinois. Seventy-one percent of mothers who were expected to deliver in non-center hospitals could have realistically been referred to perinatal centers for delivery. Ninety-four percent of realistic antenatal referrals actually occurred. In Peoria, 79% of mothers expected to deliver very low birth weight infants at non-center hospitals could realistically have been referred, to the center for delivery, and all such referrals actually occurred. Because a goal of regionalization is to deliver certain high-risk women in centers, the fact that 94% of rural and 100% of urban realistic antenatal referrals actually occurred suggests that the North Central Perinatal Region is well regionalized. Other centers should study the site of delivery of this or other well-defined regional cohorts of high-risk pregnancies to quantitate how well perinatal care is regionalized in their respective areas.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The purpose of this prospective investigation was to evaluate the outcome of trial of labor in women with a history of a single low transverse cesarean section for dystocia in comparison with the outcome in women with a history of cesarean delivery for a reason other than dystocia. During the study period, 89 of 131 patients (68%) with a history of dystocia had a successful trial of labor, compared with 78 of 96 women (81%) who had cesarean delivery for a reason other than dystocia (P< .025). Within the former group, 79% of women who originally had surgery while still in the latent phase of labor had a successful trial of labor, compared with 61% (.05<P<.10) of patients who had an arrest of dilation in the active phase of labor and 65% (not significant) of those who had an arrest of descent. The only serious complication among study patients was a single instance of uterine scar dehiscence (0.5%). We conclude that approximately two-thirds of patients with a previous cesarean delivery for dystocia will have a successful trial of labor. Of these women, those individuals whose initial operation was performed in the latent phase of labor appear to have the best prognosis for subsequent vaginal delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID