Biomedical subjects
R Toaff
Publications and source records attributed to R Toaff.
Hepatolenticular degeneration (Wilson's disease) and pregnancy. A review and report of a case.
This article presents a case report of Wilson's disease in pregnancy and a review of this entity during gestation. Biochemical and pathological data are reviewed and current treatment is discussed. Pertinent questions of interest to the obstetrician are indicated with reference to Wilson's disease.
Effect of diazepam on uterine activity during labor.
The effect of diazepam on uterine activity was assessed in a series of 30 patients in established spontaneous labor. The action of diazepam on the frequency and amplitude of contractions, uterine tone and fetal heart rate was monitored internally. An i.v. dose of 10 mg diazepam significantly decreased uterine activity by its direct effect on contraction frequency. No effect on uterine tone was seen. This effect of diazepam on contraction frequency was additional to its tranquilizing and muscle relaxant action.
Cervical incompetence: diagnostic and therapeutic aspects.
During a seven-year period, 311 women with cervical incompetence were treated by cerclage. Fifty-three of the women were treated twice during the study period, 12, three times, and one, four times, so that a total of 391 pregnancies was studied. There were only 45 emergency procedures. Candidates for elective cerclage were selected on the basis of hysterographic findings and the Hegar test. Cerclage was performed by the simple McDonald procedure, usually during the 11th to 12th week of gestation, after the presence of fetal life had been established by ultrasonic detection of the fetal heartbeats. Apart from antibiotics no medical treatment was given. Hospitalization following cerclage was reduced to less than 24 h. The fetal salvage rate was 89%, with minor differences among four etiologic subgroups. The minimum benefit rate of the operations was 64.6%. The degree of cervical patency, as established by the Hegar test, was found to be of prognostic value in cerclage-treated pregnancies. Ultrasonic detection of fetal heartbeat before cerclage significantly improved fetal salvage by almost complete elimination of early fetal loss. Simplification of the surgical procedure is recommended.
Diagnosis of hydatidiform mole with and without coexistent fetus by nonstored image echography.
One hundred ten patients suspected of having hydatidiform mole or partial mole were examined during a 21/2-year period, utilizing nonstored image echography. All echograms were performed and interpreted by an obstetrician-gynecologist. Hydatidiform mole was confirmed in 23 patients, 4 of whom presented with a coexistent fetus and 3 with blighted ovum. No false diagnoses of hydatidiform mole were made. Reasons for the superiority of a nonstored image technique are discussed, particularly with regard to elimination of primary and secondary problems inherent in echographic diagnosis.
Infertility following wedge resection of the ovaries.
Seven cases of polycystic ovarian disease were investigated by laparoscopy and endocrinologic tests after failure of ovarian resection to restore fertility. One case of bilateral and two cases of unilateral ovarian atrophy were recorded. In all seven patients the common features were extensive perivarian and peritubal adhesions. Four of the six patients amenable to cure were submitted to reconstructive surgery; three of them conceived and had normal deliveries. The present observations support the plea to relegate the surgical approach to a minor position in patients with Stein-Leventhal syndrome and stress the importance of meticulous surgical technique in the performance of ovarian surgery. Laparoscopic investigation is mandatory in all cases of unsuccessful ovarian resection.
[Ultrasonographic diagnosis in large-for-date pregnancies].
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Hyperextension of the fetal head in breech presentation: radiological evaluation and significance.
Damage of the cervical cord is not rare in breech delivery with hyperextension of the fetal head. Among 57 cases from the literature and one of ours in which the angle of extension could be measured on X-ray films, 20 had an extension angle greater than 90 degrees. Of these, 11 were delivered vaginally and included 8 cases of damage to the cervical cord. It is recommended that elective Caesarean section be performed when the angle of extension exceeds 90 degrees.
Midtrimester preeclamptic toxemia in triploid pregnancies.
Nineteen advanced triploid pregnancies reported in the literature are reviewed. In 8 of 14 pregnancies for which reliable data were available, severe preeclamptic toxemia (EPH gestosis) developed, most often from the 16th to the 24th week of gestation. In all the toxemic cases, the placenta was large for the stage of pregnancy, the placental coefficient was high (mean 0.83) and extensive areas of molar degeneration were present. Advanced triploid pregnancy is considered a further example of hyperplacentosis causing preeclamptic toxemia. The study of toxemic and nontoxemic advanced triploid pregnancies supports the assumption that hyperplacentosis, rather than being related to excessive placental size, is the expression of trophoblastic hyperactivity.
Metabolic aspects of a hypoxia test for placental sufficiency.
A hypoxia test for placental sufficiency was performed on 24 healthy pregnant women nearing term and 23 high-risk pregnant women in advanced stages of gestation. Hypoxia was induced by inhalation of a breathing mixture containing 7% oxygen through a semi-open system which permitted partial rebreathing, thus preventing hypocapnia. The changes in fetal heart rate (FHR) resulting from maternal hypoxia were recorded continuously by external or internal monitoring. The changes observed in FHR were more marked in high-risk cases. Maternal blood gases were tested before and after 10 min of hypoxia in 10 normal and 10 high-risk patients. In no case was maternal acidosis observed. All pregnant patients regarded as high-risk because of hypertensive disorders or chronic renal disease manifested metabolic alkalosis. This finding cannot be explained. It is regarded as being responsible for the more severe FHR changes through a negative Bohr effect, which reduces the dynamic exchange of oxygen in the placenta. Metabolic alkalosis does not appear in high-risk pregnant women exposed to milder hypoxia by breathing 12% oxygen. The changes in FHR observed during severe maternal hypoxia, i.e., 7% oxygen, are probably due more to maternal metabolic alkalosis than to placental insufficiency. Consequently, the "severe hypoxia test" cannot be used as a test for placental insufficiency.
Solitary abscess of the placenta in a pregnancy treated by cerclage.
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Effects of intravenous meperidine and meperidine with promethazine on uterine activity and fetal heart rate during labor.
A prospective study of the effects of the i.v. injection of 75 mg meperidine, alone or combined with 25 mg promethazine, was conducted by continuous and direct monitoring of the fetus and of intrauterine pressure. The study was carried out in 16 primiparas and 24 multiparas in active spontaneous labor with cervical dilatation of 3 to 4 cm. Administration of meperidine and of meperidine with promethazine was associated with an increase in uterine activity of 31 to 45% (Montevideo units), respectively. The most marked effects were on the amplitude of the uterine contractions. There was no significant change in uterine tone. A tetanic response was recorded in two patients who vomited after the administration of meperidine with promethazine and was followed by slowing of the fetal heart rate. In no other cases were there significant changes in fetal heart rate. Except for the latter two patients, no adverse effect of meperidine or of meperidine with promethazine on the fetal heart rate was noted. The condition of the newborns at birth was excellent in all but three cases, in two of which maternal amniotic infection and high fever were present.
Congenital adrenal hyperplasia caused by 11 beta-hydroxylase deficiency with onset of symptoms after one spontaneous pregnancy.
A case of adrenogenital syndrome due to 11beta-hydroxylase deficiency is described in a mother, 25 years of age, who had experienced a successful pregnancy 5 years previously. At that time no abnormality had been suspected and pregnancy was achieved without therapy. Subsequently the patient was examined because of secondary sterility. The menstrual cycles were anovulatory. Only slight virilization was observed and blood pressure was normal. Diagnosis was based on the observation of highly increased urinary excretion of 17-ketosteroids and 17-ketogenic steroids, with especially high excretion of tetrahydro-11-deoxycortisol. Following suppression with dexamethasone and adequate maintenance treatment, the patient conceived and had an uneventful pregnancy. This is apparently the first report of pregnancy in adrenogenital syndrome due to 11beta-hydroxylase deficiency.
Proceedings: Gas chromatography of urinary 17-ketosteroids in female infertility due to androgenic hyperactivity.
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[Asymptomatic bacteriuria in pregnancy as a public health problem].
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[Early diagnosis of molar pregnancy].
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Effect of L-dopa on galactopoiesis and gonadotropin levels in the inappropriate lactation syndrome.
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Responsiveness of the human fetus to stress.
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