Biomedical subjects
Publications and source records attributed to Y Frenkel.
Retrograde blood flow in menstruating women has been described recently. The acute event seems to be asymptomatic. Reported here is a case of an acute abdominal condition due to cervical obstruction and retrograde bleeding in a postmenopausal patient treated with estrogen-progestogen therapy.
HMG treatment is usually monitored by the evaluation of the cervical mucus, the determination of plasma 17 beta-estradiol, total urinary estrogens, ultrasonographic evaluation or a combination of these. We evaluated the daily validity of estrone-3-glucuronide excretion in urine as an indicator of follicular growth and maturation in 28 infertile women who were treated with HMG (Pergonal 500). Total urinary estrogens and estrone-3-glucuronide were measured in 24 h urine collections, and 11 of the women collected the early-morning urine separately. This allowed comparison of the concentrations and excretion of total estrogens and estrone-3-glucuronide of the 24 h urine with that found in the urine collected overnight. This comparison was made on 83 urine samples. The correlation between either the total excretion per 24 h or the concentration per liter in the 24 h urine collection of the two systems of determination was good in all determinations. Also in the urine collected on the day prior to HCG administration, total estrogens measurement was in good correlation with the estrone-3-glucuronide. However, there was statistically a significant difference in the concentrations of total estrogens and estrone-3-glucuronide between the women who ovulated and those who did not. Estrone-3-glucuronide, when calculated as a percentage of the total estrogens, was 60.86% in the women who ovulated and 33.15% in those who did not. These results demonstrate that although estrone-3-glucuronide reflects ovarian function in women treated with HMG, it may serve as a better predictor to ovulation.
In vitro prolactin (hPrl) secretion by explants of decidual tissue was studied in pre-eclampsia and normal controls. Our results indicate diminished hPrl production by decidua of pre-eclampsia as compared to the normal controls. Incubation of normal decidual tissue in the presence of serum obtained from pre-eclamptic patients did not induce an inhibitory effect on hPrl production.
The introduction of laparoscopy as a routine diagnostic tool for pelvic disorders has prompted its use in the management of uterine perforation as well. A retrospective review of 52 patients with uterine perforation secondary to curettage is presented. In 23 (44.2%) the curettage was discontinued, and the postperforation course was uneventful. Eight patients (15.4%) underwent immediate exploratory laparotomy without laparoscopy; in three of them no internal organ injury or bleeding was found. Eighteen patients (34.6%) underwent postperforation laparoscopy; seven of these women underwent subsequent laparotomy. The indications and objectives of postperforation laparoscopy are outlined. Its judicious use allows proper selection of patients for exploratory laparotomy.
During the 15-yr period from 1965 to 1979, 6 major surgical complications were encountered among 2757 consecutive laparoscopies, yielding a rate of 2.1 per 1000. Five of the complications required exploratory laparotomy (in 2 patients with small bowel perforations, 2 patients with intraabdominal bleeding and 1 patient with severe peritonitis). In the 6th patient perforation of the uterine fundus occurred during laparoscopy performed because the presence of an adnexal mass was suspected at 15 wk gestation. Laparotomy in this patient was not performed since bleeding from the perforation site stopped spontaneously. Exploratory laparotomy rather than laparoscopy should be considered for evaluation of pelvic masses suspected after the first trimester of pregnancy. A small rate of major surgical complications of laparoscopy is to be expected even when accurate technique is used.
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A case is presented in which a huge cystic mass adjacent to the outline of a 29-wk fetus was identified by ultrasonography. After delivery this was proven to be a common cloaca in a fetus with multiple congenital anomalies. The possible mechanisms of this anomaly are discussed.
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