Biomedical subjects
Publications and source records attributed to A Fishman.
The breast is an infrequent site of metastatic disease from a primary genital tract malignancy. A case of fallopian tube carcinoma metastasizing to the breast is presented. A solitary metastasis must be distinguished from the primary breast cancer as the treatment and prognosis are quite different. The pathologic diagnosis of metastatic carcinoma to the breast may be difficult if the tumor is poorly differentiated type.
Malacoplakia is an unusual type of chronic inflammation that rarely involves the female genital tract. A case of malacoplakia involving the vaginal cuff of a patient previously treated by radical hysterectomy for cervical carcinoma is presented.
OBJECTIVE: The purpose of our study was to test the hypothesis that there is no increased morbidity or mortality associated with vaginal delivery of the nonvertex second twin. STUDY DESIGN: The medical records of 781 consecutive twin gestations achieving a gestational age > or = 20 weeks and delivering between Jan. 1, 1985, and Dec. 31, 1988, were reviewed. All live-born, vaginally delivered second twins were identified, grouped by presentation, and compared with respect to 5-minute Apgar scores, length of neonatal hospital stay, neonatal intensive care unit admissions, and neonatal deaths. RESULTS: Of the 390 live-born, vaginally delivered second twins, 207 were delivered as vertex and 183 were delivered as breech. Ninety-five percent of the breech deliveries were total breech extractions. There were no statistically significant differences between the vaginal breech and vaginal vertex deliveries in any of the neonatal outcome measures studied even when stratified by birth weight. CONCLUSIONS: These results support the null hypothesis and suggest that vaginal delivery of the nonvertex second twin is a safe intrapartum management option, although no conclusion can be reached in infants weighing < 1500 gm. We found no evidence of excessive morbidity or mortality associated with total breech extraction of the second twin.
The aims of the present study were to investigate the sexual dimorphism and the role of sex steroids in GH secretion at the pituitary level, and to evaluate the ontogenesis of these effects. Towards these aims we used an in vitro perifusion system of hemipituitaries under a simulated milieu of hypothalamic factors: two 3-min pulses of GHRH at 3-hour intervals were separated by continuous flow of somatostatin. Rat GH was measured in 2.4-min fractions and analyzed by the pulse analysis program PULSAR. Pulses were similar in prepubertal male and female rats, but sexual dimorphism was evident in adults. In adult males, who had undergone neonatal gonadectomy, GH pulse amplitude and area under the curve (AUC) were lower compared to control. When gonadectomy had been performed at a prepubertal age, the pulse amplitude was still lower, but the AUC was not different from control. The gap between orchiectomy at neonatal and prepubertal age indicates the perinatal imprint, which induces an increase in AUC. Neonatal testosterone treatment of intact female rats had no effect on GH secretion by adult pituitaries. In neonatally gonadectomized female rats, under neonatal testosterone treatment, the pulse amplitude increased. A similar increase was observed after neonatal gonadectomy without testosterone treatment. We conclude that the sexual dimorphism of GH secretion is partially induced at the pituitary level and its response to the hypothalamic hormones. We assume that a neonatal imprint effect of testosterone in the male induces primarily an increase in AUC in response to GHRH. The imprint in females influences the GH pulse amplitude and AUC.
A case of uterine rupture following conservative surgery for interstitial pregnancy is presented. Even though the uterine cavity was not opened during removal of the ectopic pregnancy, attenuation of the muscle lead to subsequent rupture of the uterus in the second trimester. The option for medical termination of ectopic pregnancies located in the cornual portion of tubes is discussed.
Short stature is a prominent feature of Turner's syndrome. Various anabolic steroids and estrogens have been used, but the recent availability of biosynthetic human growth hormone (hGH) has led to its clinical evaluation in this syndrome. 10 girls with the syndrome, aged 5-13.8 years (mean 10.8), were treated with recombinant hGH. Height after 12 months of treatment was significantly greater than before treatment. The accelerated growth velocity after 1 year of treatment continued for longer periods. Girls who completed 3 years of treatment have exceeded their untreated expected adult height. No adverse reactions were noted and compliance was good. These results indicate that hGH is useful for accelerating growth velocity in patients with Turner's syndrome. Therapy that normalizes height during childhood may have important psychologic effects, and is likely to influence the child's self-image and peer relationships.
Vaginal bleeding in childhood is not a common complaint. Serious medical or sociological problems can underly this irregular symptom in young girls. Therefore it requires careful medical investigation followed by appropriate sociologic and psychologic support. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. External blood loss can be related to trauma or urologic factors. It can be the presenting sign of relatively rare benign and malignant neoplasms of the genital tract. Precocious menstruation in itself or as a part of precocious puberty must be suspected in these cases. Vaginal bleeding in prepubertal girls is uncommon but warrants careful evaluation because of the special status of the young patient.
Two hundred fifty women in labor were screened for vaginal colonization by group B streptococcus using standard culture and two rapid tests. This primarily Hispanic population had a group B streptococcus vaginal colonization rate of 2.4% (95% confidence interval 0.9-5.2%) for the patients sampled. An enzyme immunoassay and a latex agglutination test for group B streptococcus antigen both had sensitivities of 33% and had specificities of 99 and 95%, respectively, when compared with culture. Neither rapid test appeared to be clinically useful for detecting colonized women in labor, although both can be useful in excluding colonization.
In Klippel-Trenaunay syndrome there are congenital vascular malformations, usually involving the limbs. It is characterized by extreme varicose veins, bone and soft tissue hypertrophy and pigmentary skin changes in the affected limbs. We report a 29-year-old pregnant woman with this syndrome. The combination of the physiologic changes which occur in the vascular system and in blood coagulation during pregnancy, and the malformations of this syndrome is very unusual. During the patient's pregnancy there was significant worsening of the typical complications. There was extreme dilatation of varicose veins in the left leg, from the ankle up to the posterior aspect of the buttock. The involved area was swollen and edematous, and there were signs of superficial thrombophlebitis. Because we were unable to rule out deep vein thrombosis in the affected limb, prophylactic anticoagulant treatment was given during the 3rd trimester and into the early puerperium. Only then did the complications begin to resolve, but return to the prepregnant state was incomplete.
A case report which illustrates the clinical problems and sonographic difficulties that accompany the diagnosis of interstitial pregnancy are reported. Non-specific clinical symptoms and normal sonographic findings do not always preclude interstitial pregnancy.
We present a young asymptomatic woman with splenomegaly and a large isolated splenic mass demonstrated by ultrasonography, 99mTc sulfur colloid, and gallium scintigraphy studies. Computerized tomography (CT) and three-phase 99mTc-labeled red blood cell imaging suggested a malignant lesion. Repeated sonographically guided fine needle aspiration (FNA) obtained only blood, suggesting the possible vascular nature of the tumor. Splenectomy established the diagnosis of splenic hemangioma (SH) with marked sclerotic changes. We conclude from this case that 1) the sclerotic and cystic changes in the SH and the abdominal lymphadenopathy could explain why the three-phase red blood cell and CT scanning, respectively, suggested that the lesion was malignant rather than benign; 2) guided FNA of a splenic mass suspected to be hemangioma may be an additional safe and useful diagnostic procedure. Multiple aspirations yielding blood alone suggest hemangioma and may prevent an unnecessary operation. To the best of our knowledge, this is the first reported case in the literature of FNA of splenic hemangioma.
An Israeli Arab family with type I antithrombin III (AT-III) deficiency with several affected symptomatic members in three generations is reported. The propositus presented with deep vein thrombosis and pulmonary emboli associated with gestation. The propositus infant presented at the age of 2 weeks with superior sagittal and rectus sinus thrombosis. Hereditary AT-III deficiency should be considered in infants with cerebral thrombosis, especially if they have a family history of thromboembolism. The role of prophylactic therapy by AT-III concentrates in these infants should be further assessed.
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A 48-year-old female with hypercalcaemia diagnosed 3 years prior to admission is described. The patient underwent x-ray therapy of the neck for keloid scars 35 years prior to the diagnosis of hypercalcaemia. The hypercalcaemia was found to be the result of primary hyperparathyroidism. A cystic parathyroid adenoma was identified during surgery and was, on microscopic examination, composed of oxyphil cells rich in mitochondria. The cystic fluid contained 360 times higher C-terminal PTH than peripheral serum and almost 4000 times higher PTH as intact 1-84 amino acid residue species. We concluded that previous X-ray irradiation was related to the pathogenesis of the patient's parathyroid adenoma. The mild nature of the patient's hyperparathyroidism was possibly related to the composition of the tumour of oxyphil cells, known to be a poorly functioning variant of the parathyroid cell. Since parathyroid 'cysts' are obviously necrotic parathyroid adenomas, aspiration of the cysts alone cannot be expected to be curative and, therefore, it is recommended to treat cystic parathyroid adenomas by surgical extirpation.
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The infrequency of reports demonstrating dilatation of the pancreatic ducts in patients with chronic pancreatitis by CT, despite its frequent demonstration on endoscopic retrograde cholangiopancreatography (ERCP), prompted a review of 500 cases performed at the University of Miami School of Medicine/Jackson Memorial Hospital for suspected pancreatic disease. Pancreatic duct dilatation was demonstrated in 10 patients. An equal occurrence was documented in patients with chronic pancreatitis and with carcinoma. Therefore, the presence of dilated pancreatic duct only confirms the presence of pancreatic disease. No etiology should be favored by the isolated finding of a dilated duct on CT scanning.
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