Biomedical subjects
Publications and source records attributed to R R Sanders.
Anterior sacral meningocele (ASM) is well recognized in Marfan syndrome as a consequence of dural ectasia. Two cases presenting as nongynaecological pelvic masses are described highlighting the clinical difficulty in diagnosis and the classical radiological findings. The classification of ASM and associated anomalies of the sacrum are reviewed.
A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.
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Plasma prostaglandin F (PGF) was measured by a radioimmunoassay method in 24 subjects with tumours of the female genital tract. Levels in the tumour group ranged from 25 pg/ml to 134 pg/ml and were almost all greater than the values observed in a control group of 41 healthy women who had a mean (+/-SD) level of 21 (+/-3.4)pg/ml. There was a relationship between plasma PGF levels and the stage of the disease. Patients with resectable tumours showed a fall in PGF levels postoperatively and those with disseminated malignancy demonstrated increasing levels as the disease progressed. Plasma PGF may provide a clinical prognostic marker in the management of patients with malignant tumours.
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Termination of pregnancy was performed under local anaesthesia as an outpatient procedure on 251 patients. The gestational ages ranged from 5 to 12 weeks. Either the portable Karman curette equipment or the syringe kits were used. The incidence of complications was low. Only 6 per cent of patients would have preferred general anaesthesia. The optimal gestational age at which to terminate pregnancies appeared to be between 6 and 10 weeks. Ninety-one per cent of patients used effective contraception after the termination.
One hundred patients with an incomplete aboriton, 14 patients with retained products of conception after a second trimester termination, 5 patients with missed abortion and 2 patients with secondary postpartum haemorrhages (making a total of 121 patients) had a uterine evacuation in a treatment room using the portable Karman curette equipment. No general anaesthesia was used but patients were given intravenous pethidine or papavaretum (Omnopon) and diazepam. Four patients found the procedure painful but only two of them would have preferred general anaesthesia. There were no immediate complications but three patients required re-evacuation of the uterus.
The concentration of free fatty acids was measured in blood taken from the umbilical artery and vein of 29 infants during elective Caesarean section and compared with levels in maternal venous blood. The mean venous-arterial (v-a) difference was 0.07 mEq/l. There was a direct and significant correlation between the umbilical v-a difference and maternal venous concentrations.
The labour stencil representing the expected cervimetric progress of normal labour was used in 741 consecutive spontaneous labours to identify high-risk labours which needed oxytocic stimulation. Uterine contractions were stimulated if progress extended two hours past the nomogram, which resulted in shorter labours, fewer instrumental deliveries and caesarean sections, and babies with higher Apgar scores than in those dysfunctional labours which were not stimulated. According to the protocol used 36% of primigravid and 13% of multigravid labours needed acceleration. The remaining patients did not need any oxytocic interference during the first stage. This selection of patients is important to prevent a major obstetric advance being abused and discredited at a time when the profession and public are questioning the safety of active labour.
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