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Biomedical subjects

D C Cumming

Publications and source records attributed to D C Cumming.

At least 73 records · Page 4Linked to original sources
PubMed1981

6 beta-Hydroxycortisol levels in maternal urine of pregnancies complicated by prematurity.

Maternal urinary 6 beta-hydroxycortisol (6 beta-OHF) and creatinine levels were measured in 28 patients with singleton pregnancies admitted in apparent premature labor and in 17 women with singleton pregnancies delivered at term. Urine specimens were collected immediately after admission but prior to the initiation of active clinical intervention and management. Fourteen patients in true premature labor who were spontaneously delivered less than 24 hours after admission had significantly elevated 6 beta-OHF levels (1,144 +/- 210 ng/ml) compared to levels in 14 patients in false premature labor who were delivered more than 48 hours after admission (544 +/- 88 ng/ml). The mean ratio of 6 beta-OHF to creatinine was also elevated in patients in true premature labor (184.5) compared to ratios in patients delivered more than 48 hours after admission and in women in labor at or near term (range 123.4 to 128.6). The absolute levels of creatinine in all groups did not differ significantly, suggesting that the excretion of 6 beta-OHF proceeds independently of any change in renal function. Only in patients in the true premature labor group were 6 beta-OHF levels correlated with creatinine levels. However, in urine obtained within 24 hours prior to premature delivery, 6 beta-OHF levels did not appear to be related to the presence or absence of neonatal respiratory distress syndrome. It is concluded that measurement of 6 beta-OHF may provide an objective criterion for directing tocolytic therapy to those patients in true premature labor.

Creatinine↗
PubMed1980

Combined laparoscopy and hysteroscopy in the investigation of the ovulatory infertile female.

A previous study had demonstrated the superiority of hysteroscopy over hysterosalpingography for the detection of intrauterine lesions in infertile patients. One hundred and sixty-nine patients were examined by a combined laparoscopic and hysteroscopic technique as the means of detecting tubal, peritubal, peritoneal, or intrauterine causes of infertility. Laparoscopy was successful in 168 and hysteroscopy in 162. The rate of diagnosis by laparoscopy of 49.4% was increased to 66% when the hysteroscopic findings were included. Only one serious complication was recorded, the inadvertent visualization of an intrauterine pregnancy. Arguments are advanced for the replacement of hysterosalpingography with combined laparoscopy and hysteroscopy as the primary means of investigating the ovulatory infertile female.

Adolescent↗
PubMed1979

Intrauterine testicular torsion: not an emergency.

A case of intrauterine testicular torison and infarction is described. Urgent exploration of the testis has been advocated in the management of this condition. However, the risks of early anesthesia in the immediate postdelivery period must be weighed against the chances of a successful outcome of the operation in preserving testicular function. Since this salvage rate is poor, we suggest surgical exploration at a time when the infant's condition is stable, unless there are indications that the event is very recent.

Female↗
PubMed1979

Hysteroscopy in 100 patients.

Seventy-five infertile patients and twenty-five in whom displacement of an intrauterine device (IUD) had occurred were examined under general anesthesia. The Storz 4-mm hysteroscope was utilized. In all cases Hyskon, high-molecular weight dextran, was used as the distention medium. Concurrent laparoscopy was performed in 80 patients. The hysteroscopic findings were compared with preoperative salpingograms or pelvic x-radiographs. In the infertility group the technique proved to be of special value in locating intrauterine adhesions which had not been detected radiologically. In the "lost IUD" group, hysteroscopy proved to be superior to radiography in determining whether or not a device was located within the uterine cavity, and greatly facilitated removal. Failure to carry out the procedure occurred in four patients. One suffered a serious complication: anaphylaxis to the dextran. It was concluded that hysteroscopy is a simple procedure carrying little risk. It is superior to hysterosalpingography in detecting intrauterine disease which may be a cause of infertility. It is greatly superior to radiology for the detection of lost IUDs.

Adult↗
PubMed1979

Combined laparoscopy and minilaparotomy in the management of unruptured tubal pregnancy: a preliminary report.

Following laparoscopic diagnosis of unruptured tubal pregnancy, six patients underwent partial salpingectomy using a minilaprotomy technique. None of the patients had any complications resulting from the surgery. Four were discharged within 48 hours of surgery and the others on the 3rd postoperative day. When an ectopic pregnancy has been diagnosed before rupture the technique seems preferable, as it entails a less extensive hospital stay than does conventional laparotomy. The smaller incision is more comfortable and is cosmetically acceptable. The technique is relatively easy to use, and it is hoped that the minimal invasion of the peritoneal cavity will have a less deleterious effect on future fertility.

Fallopian Tubes↗
PubMed1979

Recurrent nonimmune hydrops fetalis.

A case of recurrent nonimmune hydrops fetalis is presented. In each of the 2 pregnancies involved, early neonatal death occurred. Only 1 other case could be discovered in the literature where the problem recurred. Hence, normally, a good prognosis for future pregnancies is given. In spite of extensive investigation, the etiology of nonimmune hydrops fetalis remains unknown. The condition is associated with preeclampsia, polyhydramnios, and premature labor. While the polyhydraminos renders management difficult, it makes the ultrasound diagnosis much clearer. This early diagnosis ensures the availability of optimal perinatal care for the infant on delivery.

Edema↗
PubMed1979

Historical predictability of abnormal laparoscopic findings in the infertile woman.

The conventional approach to laparoscopy in an infertility workup has been to perform the procedure in the latter stages. Alternative ways have been suggested. Our investigation attempted to assess the suitabilities of an alternative approach. The laparoscopic findings in a group of 231 patients examined as part of an infertility workup have been analyzed. The predictability of abnormal findings has been demonstrated with accuracy in those patients with certain symptomatic or historical associations. The ability to predict abnormalities would suggest that laparoscopy should be performed early in the workup in this group. This holds true regardless of the discovery of any other abnormality which might be thought to be related to the patient's infertility.

Adult↗
PubMed1979

Spontaneous rupture of a primigravid uterus.

The spontaneous rupture of the primigravid uterus is an obstetric rarity prior to the onset of labor. Invariably there is a history of antecedent scarring. A case of uterine rupture is reported on where the only antecedent history was damage by the second trocar during laparoscopy. The use of electrocautery and the immediacy of subsequent conception are probably implicated in the pathogenesis. It is recommended that should the fundus be damaged during laparoscopy as part of a subfertility investigation, barrier contraception should be advised for a two-month period.

Adult↗
PubMed1979

Urologic and obstetric significance of urinary calculi in pregnancy.

Thirteen patients whose pregnancies were complicated by urinary calculi are presented. Difficulties of diagnosis and treatment with reference to obstetric outcome were assessed. In this series the evidence shows that diagnosis with a high index of suspicion is not difficult. There are apparently no ill effects on the pregnancy from the calculus nor from any necessary surgical management.

Adult↗
PubMed1978

Puerperal uterine inversion: report of nine cases.

Acute puerperal inversion of the uterus is considered to be rare. In one institution there were nine cases during an 11-year period, a rate of one for every 2176 vaginal deliveries. Analysis of these cases failed to identify any contributing factors occurring during the first or second stage of labour. Six cases were directly attributable to failure to administer an oxytocic preparation or, particularly, failure to await uterine contraction before attempting to expel the placenta by fundal pressure or cord traction. Although active management of the third stage of labour may reduce the incidence of postpartum hemorrhage, incomplete application of its principles is extremely hazardous. Immediate uterine replacement was efficacious in seven cases, but the inadvisability of removing the placenta prior to replacement was demonstrated.

Acute Disease↗
PubMedDate not supplied

Tamoxifen in breast cancer: symptom reporting.

Clinical studies have traditionally identified treatment-specific side effects by comparison of voiced side effects in treatment and placebo arms of a study. Highly motivated women in a clinical trial may underreport drug-induced symptoms for medications which may be considered lifesaving. Affective symptoms during treatment of early breast cancer with tamoxifen (an estradiol receptor antagonist) were reported as infrequent by the manufacturer. However, reports suggest a higher rate of depression during general use. The objective of the present study was to examine the frequency of symptoms that might be side effects of tamoxifen and to relate them to the way the women attributed such symptoms. The exploratory study involved semistructured telephone interviews of 25 women who were taking tamoxifen. Textual analysis of the information was used to examine the symptoms described by the women. They were also asked whether any symptoms were related to the medication. The symptoms and their attribution were evaluated against a background of self-perceived stress. The principal finding was a pattern of ambivalence in attributing symptoms to the drug. Of all the symptomatic changes noted, the women only attributed 51% to tamoxifen. Flushes, fatigue, and depression were reported most frequently during treatment; flushes were readily attributed to tamoxifen but depression and fatigue were attributed to another factor by half of the symptomatic women. Women who reported moderate to high levels of life stress were less likely to attribute symptoms to drug therapy. The results suggest that women taking tamoxifen may not attribute known drug side effects to use of the medication.

Aged↗
PubMedDate not supplied

Androgenesis and androdynamics in normal women.

The effects of estrogenic steroid hormones in women are apparent, but the circulating androgen levels are much higher. Compared with serum estrone and estradiol levels, circulating testosterone levels are five to 10 times higher, androstenedione levels 30 times higher, dehydroepiandrosterone levels 100 times higher, and dehydroepiandrosterone sulfate levels 40,000 times higher. Androgen production in women is physiologically appropriate, but it differs from other hormonal systems in that there seem to be no mechanisms controlling the serum levels. Androgens are produced almost incidentally from reproductive and ACTH-adrenal axes. No distinct feedback systems have been identified for the androgens, although the lifetime patterns of changes, particularly of adrenal androgens, suggest that such systems should exist. Normal androgenesis from the two axes and the mechanisms of androgen action are described, as an introduction to abnormal androgen action in women.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Menarche, menses, and menopause: a brief review.

Reproductive maturation, the menstrual cycle, and the transition to postreproductive life are complex processes. Detailed understanding of reproduction underlies logical patient management. Greater understanding of physiology has brought about better control of ovulatory problems and the beginnings of a logical approach to other problems such as androgen excess, where two complex systems overlap.

Child↗