Alfred J. Kobak

Ruptured spleen simulating ectopic pregnancy

Abstract 1. 1. A case has been reported of massive intra-abdominal hemorrhage from a ruptured spleen clinically simulating a ruptured ectopic pregnancy. 2. 2. It is suggested that colpocentesis be utilized as an aid in the diagnosis of intra-abdominal bleeding from any source.

Prophylactic chemoantibiotic therapy and low cervical cesarean section in potential and actual infections

W HEN a low cervical cesarean section can be safely performed despite the presence of unfavorable conditions t,hat invariably cause postoperative sepsis, obstetricians will have attained a long-sought goal. Studies of maternal mortalities’ in the past twenty years have revealed that sepsis was the most frequent cause of death and, likewise, a factor in almost f i f ty per cent of the fatalities that followed the performance of cesarean sections. Changes in cesarean section techniques were frequently made during the past twenty-five years in order to reduce the high mortality from sepsis. The low cervical type to a large extent replaced the classical operation. However, postoperative sepsis continued to complicate the recovery of the patient, particularly when it. was preceded b> prolonged labor, many hours of ruptured membranes, many vaginal examinations, and previous manipulative attempts to deliver the fetus. With these conditions present, the transperitoneal cesarean was considered too risky, and some institutions preferred the cesarean hysterectomy. The latter had the disadvantage of sacrificing the uterus in a young woman. A revival of the extraperitoneal cesarean followed, but was not univcrsal1.v adopted. Many found it necessary to practice and perfect the technique on elective ceases. To reach thtl uterus and extract the fetus, a most unnatural anat,ornie route must be taken. The peritoneal cavity frequently is inadvertently openecl and the bladder, it not, perforated or damaged during the operation, appears raw. denuded, and traumatized (Ricei,” Waters,3 Keet,el and Randall” 1. As the newer extraperitoneal cesarean techniques were being introduced, sulfonamide and antibiotic drugs appeared as potent ba.cteriostatic agents. As t)hese drugs became ava.ilable, morbidity and mortality from general and postoperative sepsis dropped considerably. Consequently. those employing either the transperitoneal or extraperitoneal techniques are now using chemoantibiotics when sepsis t,hreatens recovery. If chemoantil)iotics can prevent and con1ba.t sepsis, the operative procedure, when needed, should be the one t,hat is lrast traumatic to the mother, and offers no t,echniral dificulty. Thus, when sepsis is potentially or actually present and an abdominal delivery is deemed necessary, one may employ tile low cervical section, and the use of chemoantibiotics

Skin Reactivity of Mothers and Infants to Gonococcus Vaccines.

Conclusions The poor skin response to gonococcus antigens to which newborns and older infants are clinically more susceptible resembles that of other bacterial preparations similarly used. We believe this phenomenon (“anergy”) to be due to an underdeveloped mechanism for dermal reactivity in early age.