Biomedical subjects
Publications and source records attributed to M Borten.
Ferning of amniotic fluid was studied in early pregnancy. Arborization was demonstrated during the interval of 6 1/2 to 16 weeks by flame-drying. Air-drying yielded a spectrum of crystallization from none prior to 8 weeks to full ferning by 16 weeks. Technical differences are stressed.
Maintenance of an adequate pneumoperitoneum is important in laparoscopy, yet little is known about the functioning of laparoscopic insufflators except for the manufacturer's description of the specifications. Frequent failure to maintain an established pneumoperitoneum with the insufflator switched to its automatic mode prompted evaluation of the volume of gas delivered per unit of time by machines in active use. Limited standardization was found between machines in regard to the gas flow mediated by the automatic flow control. In this mode, the insufflator did not adequately compensate for changes in resistance to flow. Disparity of response among flow control devices and interinstrument variations suggest the need to test and calibrate each unit separately for clinical use.
The use of the laser for translaparoscopic surgery has brought with it a renewed interest in single-puncture operative laparoscopy. Concern about the extent of visual obstruction created intraoperatively by the use of ancillary instruments through the accessory channel prompted this evaluation. Under normal operative conditions, a 5-mm instrument protruding 10 mm or more beyond the distal end of the laparoscope will obstruct 14.6% of the operator's visual field. Still greater curtailment of endoscopic visualization can be expected when large, modified laser probes are used. The double-puncture laparoscopic technique must be considered the method of choice for translaparoscopic conventional or laser surgical procedures.
The availability and efficacy of prostaglandin (PG) F2 alpha and E series analogues has prompted their frequent use for pregnancy interruption. In the course of evaluating our experience with PGs for interrupting early first trimester gestations, we became increasingly impressed by the absence of any with extrauterine pregnancy. A review of 63 reports encompassing 2,965 patients whose pregnancies were less than 8 weeks' gestational age dating from the last menstrual period and who were similarly treated yielded only 2 cases of ectopic pregnancy. When compared with the generally accepted ectopic gestation rates of the order of 1 in 200 pregnancies, this frequency of 1 in 1,483 is unexpectedly low. Preselection does not appear to explain this impressive discrepancy. If the observation proves correct, it implies that PGs have some form of therapeutic effect in eradicating extrauterine pregnancy by nonoperative means. The implications are obvious in terms of its potential therapeutic benefits.
Pregnancy was interrupted successfully in 70% of 20 early pregnancies, 35-49 days in duration as dated from the first day of the last menstrual period, by administration of a single intravaginal suppository containing 3 mg of (15S)-15-methyl prostaglandin F2 alpha (PGF2 alpha). No correlation could be demonstrated with baseline beta-subunit human chorionic gonadotropin or serum levels of prostaglandin obtained within ten hours of treatment. Continued pregnancy was documented in 10%. The rate of failures and the frequency of gastrointestinal side effects were deemed too great to warrant adopting this agent for clinical usage.
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The trauma of mechanical cervical dilatation preceding abortion is directly related to the degree of cervical resistance. Prostaglandins may reduce cervical rigidity but are accompanied by undesirable side effects. Our aims were to ascertain if a low-dose (10 mg) analogue (9-deoxo-16, 16 dimethyl-9-methylene PGE2) is effective and well tolerated and, if so, to try to determine the possible mechanism by which it works. To this end, we studied 39 women with gestational ages ranging from 7 to 19 weeks who were given a single vaginal suppository 1 to 4 hours before suction curettage. In addition to demographic data on age, gravidity, parity, and previous abortions, we determined progesterone, human chorionic gonadotropin and prostaglandin plasma levels. This low-dose prostaglandin E2 analogue was found to be effective in achieving cervical dilatation and softening with minimal side effects (mild nausea in one patient only). Mean cervical dilatation achieved was 7.8 +/- 2.3 mm. Softening was apparent and facilitated additional instrumental dilatation when required. No correlation was found between drug effectiveness and gravidity, gestational age, or duration of action. There was no detectable trend with regard to baseline progesterone or human chorionic gonadotropin levels. This suggested a specific sensitivity to the local effect by the drug, apparently unrelated to dosage.
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The workup of a pelvic mass should not be limited to intraperitoneally located organs. Pathologic conditions of the abdominal wall, although rare, can mimic an intraabdominal process. One example of such conditions is the spontaneous (atraumatic) appearance of an abscess in the retrofascial-prevesical space of Retzius.
Controversy surrounds the need for a waiting period (equilibration, or cooling period) before obtaining a breast thermogram. Temperature differences between an intrinsic lesion (carcinoma) and the overlying skin are said to be amplified by cooling of the skin. Some investigators have found no qualitative difference between thermographic evaluations done 3-15 minutes after the patient disrobes; others assert that tests done within this period are invalid. We evaluated nine ovulatory women thermographically twice during a menstrual cycle (proliferative and secretory phases) to ascertain the significance of such a waiting period and to investigate when thermal equilibrium is achieved with the environment. Breast thermograms were obtained with a cholesteric liquid crystal contact plate at 1-minute intervals for a 20-minute period following exposure of the breast to a room temperature of 72 F (22 C). A significant drop in breast skin temperature was found to occur during the first 15 minutes before equilibrium takes place; this finding suggests that a waiting period is necessary for accurate evaluation.
By means of simple changes in the observation and recording process after induced first-trimester abortion, it has been possible to reduce the frequency of failed abortion to one third its former incidence. The operator is merely required to note whether the amniotic sac and fetal parts are actually seen on gross examination and flotation in fluid. This formal requirement appears to serve as an alert mechanism to ensure that women at risk will be effectively evaluated and managed.
The use of intraperitoneal dextran at the conclusion of a gynecologic surgical procedure to prevent postoperative adhesions has increased recently. Although anaphylactic reaction to dextran administered intravenously is well documented, the authors report such a reaction after intraperitoneal administration. The delayed appearance and the continuation of the undesirable reaction until the intraperitoneal reservoir of dextran was removed by means of a culdocentesis are noteworthy. Physicians should be alerted to this potential complication.
Laparoscopy has become an integral part of the gynecologist's armamentarium in the diagnosis and treatment of abdominopelvic conditions. Although it was originally designed only for diagnostic purposes, experienced laparoscopists are performing an increasing amount of surgery translaparoscopically, thereby avoiding the need for major surgical procedures, such as laparotomy. Evaluation of a source of active bleeding is a common indication for diagnostic laparoscopy. A suspected uterine perforation during dilatation and curettage requires such an investigation in most instances when active bleeding is suspected. We report two instances in which laparoscopic visualization identified a source of continuous bleeding at the uterine serosal surface following perforation during curettage. Translaparoscopic application of a microcrystalline collagen hemostatic substance (Avitene) was used to control bleeding at the hemorrhagic site and thus avoid a major abdominal surgical procedure.
Thermography of the breast is considered by some to be a risk marker for the presence of abnormalities of the breast. Circadian variations in the temperature of the skin of normal and cancerous breasts have been documented. A temporal study was undertaken to verify whether or not thermograms obtained at different hours of the day are sufficiently similar to be clinically useful. Eleven healthy women underwent four serial thermographic evaluations each at three to four hour intervals. Significant differences were observed between the early morning results and subsequent evaluations. Reproducible thermograms were obtained for all studies done from 12 noon onward. This is a possible indication that the timing of thermographic examinations has to be standardized to ensure that reliable comparisons are being made.
The temporal relationship of oocyte maturation to endogenous luteinizing hormone (LH) in vivo throughout the preovulatory period has not been previously reported. In order to study in vivo oocyte maturation follicular aspiration was carried out from 4 to 38 hours after the onset of the LH surge. Oocytes were obtained in 72% of cases. If oocytes were harvested more than 18 hours after the onset of the LH surge, resumption of meiosis had occurred. Twenty-eight to thirty-eight hours after the onset of the LH surge preovulatory oocytes in metaphase II were obtained. A corpus luteum was found 38 hours after the onset of the LH surge.
We evaluated the cervical dilator device (CDD), an expanding balloon, as a substitute for laminaria tents before abortion at 13 to 16 1/2 weeks by extraction and vacuum curettage. The CDD was found to be an effective dilator, although it did not appear to have any advantage over laminaria tents when placed overnight and was associated with significant pain upon insertion and an apparent increased risk of endometritis. The present CDD or a subsequent modification may offer advantages over laminaria tents for short-term placement.
A new balloon-type cervical dilating device (CDD) was inserted just after intra-amniotic infusion of a combination of prostaglandin F2alpha and hypertonic saline in an effort to shorten the interval from infusion to abortion. The CDD has both dilator and anchor balloons which are inflated with normal saline after insertion into the cervical canal. The infusion-to-abortion interval was shorter in patients with the CDD dilator inflated (14.6 +/- 2.1 hours) than in those with both dilating and anchor balloons inflated or in those aborting without the device in place at all (23.0 +/- 1.7 and 18.8 +/- 1.0 hours, respectively).
The possibility that an abnormal Papanicolaou smear of the uterine cervix may be associated with vaginitis due to trichomonas vaginalis has been known for some time. Since colposcopy is being used with increased frequency to evaluate patients with cytologic abnormalities noted on the cervical smear and the colposcopic changes produced by trichomonal vaginitis are quite typical, a study was designed to evaluate the duration of these changes after effective eradication of the parasite. Among 12 patients in whom the infection was successfully treated, none showed evidence of colposcopically detected abnormalities due to the trichomonal vaginitis at 2 weeks and again at 4 weeks after initiation of therapy.