Albert Altchek

Renal Biopsy and Its Clinical Correlation in Toxemia of Pregnancy

Through the combination of a renal biopsy technique modified for pregnant women, electron microscopy, and knowledge of fine (ultramicroscopic) glomerular anatomy, the pathology of the renal glomerular lesion of toxemia of pregnancy (preeclampsia-eclampsia) has been defined. The lesion is pathognomonic and consists of swelling of the cytoplasm of the endothelial cell, deposits underneath the basement membrane and within the swollen endothelial cytoplasm, and an increase of intercapillary cells. The lesion reduces the glomerular capillary lumen. It is the most sensitive pathological lesion of toxemia in the body, and is present in all cases of toxemia. Once formed, the lesion persists until evacuation of the uterus, in spite of apparent clinical improvement with therapy.The lesion accounts for the characteristically decreased glomerular filtration rate in toxemia, and this may be a factor in the formation of edema. Demonstration of the lesion is the only laboratory method that can reliably differentiate toxemia from uncomplicated essential hypertension (preeclampsia may be superimposed on essential hypertension): the presence of the glomerular lesion indicates toxemia, while absence of the lesion indicates that the illness is not due to toxemia. A severe glomerular lesion indicates impending fetal death.Although renal biopsy is mainly of investigative use in obstetrics, it is a valid diagnostic tool for discovering or dismissing the possibility of chronic renal disease.

Squamous papilloma with hyperpigmentation in the skin graft of the neovagina in Rokitansky syndrome: literature review of benign and malignant lesions of the neovagina.

BACKGROUNDnIt is rare for a benign or malignant neoplasm to develop in a neovagina.nnnCASEnThis is the first report of a squamous papilloma with hyperpigmentation which developed in the neovagina 12 years after a McIndoe procedure was done with a split-thickness skin graft from the patients buttock. The patient had congenital absence of the vagina and uterus (Rokitansky syndrome, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH syndrome). It presented as post-coital blood spotting for 3 months.nnnCONCLUSIONnAs a routine, all cases of vaginal construction regardless of the reason for the surgery or the lining of the neovagina should have a continuous annual examination and careful inspection of the entire vagina. Biopsy of any unusual finding should be done. Despite the dark color of the vaginal lesion, bleeding and rapid appearance our patient had a benign tumor. Radiation therapy to the neovagina and prolonged treatment with podophyllin and cauterization should be avoided.

Digital vascular reactivity to L-norepinephrine in the second trimester of pregnancy as a test for latent essential hypertension and toxemia.

I N 1 9 5 7 1 neurogenic vasoconstriction was estimated quantitatively by measuring blood pressure and blood flow in the digit under standardized conditions of rest and room temperature and again after vasodilatation by indirect heat supplemented by the intravenous injection of a ganglion-blocking drug. These data were converted to radius equivalents by means of PoiseuiIles law ancl from these radius equivalents and the pressures the physical work performed by the smooth muscle of the blood vessels in changing one steady state (vasodilatation) to another (vasoconstriction) was calculated. With these methods, neurogenic vasoconstriction was demonstrated to be increased over normal values in essential hypertension. A similar procedure was subsequently applied to estimating vascular reactivity to L-norepinephrine (NE) by measuring the work of vasoconstriction produced by digital vascular smooth muscle in response to a fixed rate of infusion of NE.2 Such reactivity was found to be strikingly and uniformly increased in essential hypertension.

Sarcoidosis of the uterus

Abstract 1. 1. A case of generalized sarcoidosis with asymptomatic uterine involvement is reported. Characteristic epithelioid granulomas were found in the endometrium and myometrium of a uterus removed by vaginal hysterectomy. 2. 2. Although sarcoidosis is a systemic affection with multiorgan involvement, localization in the uterus is extremely rare. A survey of the literature discloses reports of only five previous instances of uterine sarcoidosis. 3. 3. Though in three cases curettage was performed for abnormal bleeding, it seems unlikely that the sarcoid uterine granulomas were responsible for the symptoms. 4. 4. The finding of tuberclelike granulomas in the endometrium or myometrium should alert one to the possibility of sarcoidosis. The diagnostic criteria of this disease are described. Differentiation must be made from tuberculous and foreign body reactions.

The work and force of digital vasoconstriction in normotensive and hypertensive pregnant women

Abstract 1. 1. Arterial pressure and flow were measured in the digital circulation both before and after vasodilatation in normotensive and hypertensive pregnant women in the third trimester. The work, work index, and force of vasoconstriction and caliber changes were calculated from the data. 2. 2. There was some increase in neurogenic vasoconstriction in the hypertensive group. 3. 3. Pregnancy itself tended to decrease neurogenic vasoconstriction in both groups, probably because of increased heat production. Normal pregnancy, moreover, tended to decrease the brachial-digital systolic pressure gradient.