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L A Cibils

Publications and source records attributed to L A Cibils.

At least 37 records · Page 2Linked to original sources
PubMed1987

Pseudosarcoma botyroides in pregnancy: report of a case with ultrastructural observations.

A case of pseudosarcoma botryoides of the vagina diagnosed in advanced pregnancy is described. The cellular characteristics (atypical cells and abnormal mitoses) suggested malignancy, but ultrastructural studies demonstrated the fibroblastic nature of the cells, thus confirming the diagnosis of pseudosarcoma. Local excision and subsequent cesarean section was the method of treatment. Three years later, another pregnancy was terminated by repeat cesarean section and uncontrollable hemorrhage requiring emergency hysterectomy. The histologic study of the bleeding area revealed very edematous areas and lacunaelike endothelium-lined vessels. No cellular abnormalities were observed.

Adult↗
PubMed1984

Clinical significance of fetal heart rate patterns during labor. VIII. Breech presentations.

The fetal heart rate (FHR) tracings of 302 consecutive breech presentations were analyzed to assess their potential value in clinical practice. There were 274 singleton births, 27 first twins and 1 triplet. Ten percent of the gestations were greater than or equal to 42 weeks, and 26% were less than or equal to 36 weeks. Infants premature by weight (less than 2,500 gm) made up 32%. Only 33.3% had no decelerations, and 63.0% had variable or variable-late decelerations. The latter group had a significantly higher incidence of depressed neonates and neonatal deaths. When accelerations were present, there were significantly fewer depressed infants and neonatal deaths. Overall the perinatal mortality (PNM) was 7.9%; for premature infants it was 27%, postterm 3% and term 1%. There was a 31% incidence of cesarean section. The PNM, when analyzed according to route of delivery, was no different for the very-low-birth-weight, low-birth-weight and term infants. Weight-specific mortality accounted for the apparent difference among the very-low-birth-weight infants. The high incidence and pathophysiology of cord compression (for first- and second-stage labor) may explain the higher incidence of depression in breeches as compared to cephalics. FHR monitoring should be done throughout delivery in order for the physicians to intervene on time when fetal distress is imminent.

Birth Weight↗
PubMed1983

Midforceps delivery: a critical review.

A survey of results of midforceps delivery in mother and fetus was carried out, reviewing the most relevant publications of the past several years. Many discrepancies have been found from definition of what is (or should be) considered midforceps delivery to methods of gathering the material for analysis and the statistical evaluations. Specific study of some of these results was done which revealed possible flaws in the conclusions reached by the authors. Clearly maternal mortality is no longer a justifiable aspect to be studied. However, maternal morbidity should be considered and compared to that associated with vaginal and/or cesarean section deliveries. Likewise perinatal mortality and morbidity should be the standard of study and, in particular, long-term follow-up of infants delivered by the various methods. Until those observations are made from reliable data of comparable populations, it is probably not justified to condemn midforceps deliveries well conducted and judiciously indicated.

Anesthesia, Conduction↗
PubMed1982

Ultrastructural and histochemical observations of neuroendocrine granules in nonneoplastic ovaries.

Argyrophil and argentaffin cells are rarely seen in female genital tract structures. Their presence in normal, apparently healthy ovaries has not been reported until the present observation. Histochemical and ultrastructural studies demonstrated cells within the ovaries of two nonpregnant patients in the reproductive age that belong to the neuroendocrine or amine precursor uptake and decarboxylation (APUD) system. The lack of other discernible pathologic conditions suggests that these cells may be normal cellular constituents within the ovaries and lends support to the belief of a neural crest origin for primary ovarian carcinoid not associated with teratomatous or mucinous elements.

APUD Cells↗
PubMed1980

Clinical significance of fetal heart rate patterns during labor. VI. Early decelerations.

In a population of high-risk patients who had continuous "direct" monitoring during labor, 598 (46%) had no decelerations during the first stage, while 247 (19%) had presented early decelerations before completion of dilatation. The clinical characteristics, the fetal heart rate (FHR) baseline alterations, and neonatal outcome were compared between these two groups: there were no differences in any of the aspects evaluated, except that there was transient tachycardia more often among the early-decelerations group. The patients who had no decelerations were subdivided into vaginal deliveries and cesarean deliveries, and the same parameters were compared again: the cesarean section group had longer recordings and more contractions, lower Apgar 1 and 5 minute scores, and higher incidences of Apgar scores less than or equal to 6 at 1 minute, while all other aspects were similar. A possible explanation was that 82% of cesarean sections were done under general anesthesia and only 3% of vaginal deliveries. The implication of ruptured membranes in the etiology of early decelerations was extensively reviewed and discussed in view of these findings. It is concluded that amniotomy does not seem a maneuver deleterious to the fetal well-being.

Adult↗
PubMed1978

Clinical significance of fetal heart rate patterns during labor. V. Variable decelerations.

Among a large series of high-risk patients who had direct electronic monitoring, 330 fetuses presented "variable" decelerations and 598 had no decelerations. Among those with variable decelerations, there were 18 who presented such associated fetal heart rate (FHR) alterations as tachycardia, fixed baseline, and slow recovery ("hypoxic components"). The fetal outcome, as well as the characteristics of FHR patterns, were compared among the three groups. Baseline changes were significantly higher among pure variable decelerations and still higher among those having variable decelerations with hypoxic components. Likewise, one- and five-minute Apgar scores were significantly lower in that order. Only 4 per cent with no decelerations had clinical fetal distress while 23 per cent with variable decelerations and 78 per cent of those with variable and hypoxic components had distress. Neonatal death was higher among groups with variable decelerations. Premature rupture of membranes seemed to be the only clearly different (and probably influencing) clinical condition, being higher among the group with variable decelerations. Variable decelerations ("cord patterns") are associated with a relatively high rate of depressed infants. This problem is much worse when elements characteristic of hypoxia are identified in FHR tracings. The degree of drop in FHR frequency is not among those elements so identified. It is thus possible to prevent significant fetal deterioration by meticulous analysis of FHR tracings and active management when "late" components are identified on variable decelerations.

Electrocardiography↗
PubMed1976

Response of human uterine arteries to local anesthetics.

The in vitro effects of local anesthetics and norepinephrine upon strips of early gestation and term pregnancy uterine arteries were studied in eight cases. In another case, the effect upon uterine veins was studied with a standard organ bath used to record isometric contractions. Histologic preparations were made to verify the type of vessel studied. An artery obtained from an eight-week gestation did not respond to either lidocaine or mepivacaine. All other arterial specimens (radial and helicoidal strips) responded with slow, rising, strong contractions to diluted concentrations of both of these substances. Likewise they responded with rapid contractions when exposed to norepinephrine. Alpha blockers were unable to prevent the contractions triggered by the local anesthetics. The vein specimens did not respond to local anesthetics but contracted when stimulated by norepinephrine. Based on these observations and after brief review of some hypotheses advanced to explain post-paracervical anesthesia fetal bradycardia, it is postulated that this bradycardia is probably due to uterine artery spasm, causing decreased intervillous space blood flow and fetal hypoxia.

Anesthesia, Obstetrical↗
PubMed1976

The effect of epidural anesthesia on uterine activity and blood pressure.

Because of the unresolved controversy regarding the effect of epidural anesthesia upon uterine contractility, it was decided to study its effect on a small number of patients. Intrauterine and intra-arterial continuous pressure, continuous fetal heart rate, and maternal heart rate recordings were obtained from at least 20 minutes before administration of the epidural anesthic until complete dilatation in these patients. Nineteen patients were in spontaneous labor, and 18 had labor stimulated with oxytocin. Plain lidocaine, 1 or 1.5%, was used in 12 patients (30 observations), and lidocaine with epinephrine, 1:200,000 was used in 26 patients (51 observations). Uterine contractions were calculated in Montevideo units for 60 minutes following the epidural anesthetic. The changes, if any, were compared in both groups. There was a significant decrease in uterine activity when epinephrine was added to the anesthetic solution, mainly a lessening of intensity. There were comparable decreases in systolic/diastolic blood pressure in both groups and compensatory tachycardia. In one case, severe hypertension was observed following administration of lidocaine epinephrine. It was concluded that the addition of epinephrine to the anesthetic solution predictably produces diminution of uterine activity, and it does not give "cardiovascular support" to the laboring patient.

Anesthesia, Epidural↗
PubMed1976

Clinical significance of fetal heart rate patterns during labor. I. Baseline patterns.

From a population of 2,774 high-risk patients monitored during labor, 1,304 single pregnancies in cephalic presentation and with direct monitoring for at least 1 hour before completion or cesarean-section were studied. The maternal and fetal clinical data and the tracings were hand reviewed, coded, and programmed for computer analysis. In the record were studied baseline, its changes (tachycardia, fixed, saltatory), the accelerations, and the decelerations (early, variable, late). Fifty-four per cent had some type of FHR deceleration. Accelerations were recorded in over 12 per cent of all cases and were associated with cord problems in 41 per cent. Subgrouping the patients by age of gestation (less than or equal to 36 weeks, 37 to 41 weeks, and greater than or equal to 42 weeks) revealed a 10 per cent prolonged gestation rate and only 6.8 per cent premature; these had a lower 5 minute Apgar score. Fetal weight and age were positively correlated with Apgar score. Baseline changes were much frequent among pre- and postmature infants, particularly tachycardia in the latter (40 per cent). The premature infants had a 25 per cent incidence of fetal distress and the postmature infants had 20 per cent. Neonatal morbidity and mortality rates were very high among premature infants and a mortality rate of 2.3 per cent was found among postmature infants. Saltatory pattern and particularly fixed baseline seem characteristic of prolonged gestation and placental insufficiency. With tachycardia, they constitute subtle symptoms of fetal distress.

Delivery, Obstetric↗
PubMed1975

Clinical significance of fetal heart rate patterns during labor. II. Late decelerations.

Among a population of high-risk patients in labor who had continuous "direct" electronic monitoring, 147 presented late decelerations and 598 had no decelerations at the time the first stage was completed, or a cesarean section decided upon. A variety of clinical aspects of mother and fetus were analyzed, considering some alterations observed in the FHR pattern. Apgar scores were lower among decelerations, and there was a negative correlation between these two. Maternal pathology, other than PRM, was higher among decelerations and these required enhancement more often. There was very high association with tachycardia, saltatory, and fixed baseline among decelerations, and these infants were very often distressed and born depressed. Within the group of decelerations, small fetuses had lower Apgar scores. There was a negative correlation between number of decelerations and Apgar score. The small fetuses had a high incidence of tachycardia and fixed baseline, saltatory being almost absent. Their neonatal outcome was poor. A comparison of fetal response to distress was done considering age of gestation (premature, term, and postmature) and found to be different. The mechanisms involved in late deceleration are discussed, reviewing the published experimental work. When interpreting FHR patterns, age of gestation should be one of the most important considerations.

Apgar Score↗
PubMed1975

Permanent sterilization by hysteroscopic cauterization.

A small series of 22 patients who underwent hysteroscopy cauterization is reported. The uterus was distended with CO2 and dextran. Cauterization was done with a 6 mm. long, active-tip, No. 4 electrode: There was a 27 per cent failure rate for the controlled cases, this dropping to 11 per cent after recauterization. A significant complication, small bowel perforation, was treated by resection and anastomosis with complete recovery. The uterine distention with CO2 is safe but ostium visualization is not very good; Dextran distention is more cumbersone but gives excellent visualization and exposure of the ostium because higher intrauterine pressures are developed.

Anesthesia↗