Arthur I. Goldstein

Abnormal cervical cytology in the teen-ager: a continuing problem.

Abnormal cervical cytology is being discovered in an alarming number of sexually active teen-agers. Over an 18 month period, cytology consistent with mild dysplasia or worse was noted in 188 of 2,655 teen-agers screened. This represents a rate of 70.8 per thousand. Colposcopically directed biopsies in 65 patients revealed 15 cases of severe dysplasia-carcinoma in situ. Cryosurgery was the principle method of treatment and, combined with colposcopy, is a safe and effective means of managing these patients.

Vaginal and cervical communication with mesonephric duct remnants: Relationship to unilateral renal agenesis

Abstract Two cases involving a communication between a vestige of the mesonephric system and the cervix or vagina are presented. The relationship between gynecologic and urologic malformations is discussed. Presence of various abnormalities in one system warrants investigation of the other.

Epidural analgesia and cardiac output in severe pre‐eclamptics

Labour and delivery cardiac output was assessed by thermal dilution in ten severe pre‐eclamptics who received lumbar epidural analgesia. Control cardiac output was 8·8 litres/min which remained statistically unchanged following administration of lumbar epidural analgesia. At birth and delivery of the placenta, there was a moderate increase in cardiac output which increased significantly (28%) by 15 min after delivery of the placenta. Subsequently over the next hour, cardiac output returned toward baseline levels. Mother and fetus were stable throughout and infant Apgar scores were good. These results emphasise that lumbar epidural analgesia has little effect on cardiac output in severe pre‐eclamptics.

Intussusception of the Appendix Associated with Endometriosis

ALTHOUGH SEVEN cases • 8 of intussusception of the appendix associated with endometriosis have been reported,* all but two were symptomatic (Table 1). In one of the cases, endometriosis with intussusception was encountered incidental to hysterectomy for uterine leiomyomas. In the second case, during cholecystectomy for cholelithiasis, palpation disclosed an umbilicated cecal mass suggestive of a malignant neoplasm. A right hemicolectomy and ileotransverse colostomy were consequently done. Endometriosis was found within the wall of a totally inverted appendix. We are reporting the third case of asymptomatic intussusception of the appendix associated with endometriosis.

A prospective investigation of the etiology of febrile morbidity following abdominal hysterectomy.

Abstract A prospective study of 100 consecutive cases was undertaken to elucidate more clearly the causes of febrile morbidity following identical pelvic operations performed by the same surgeon in one hospital. Febrile morbidity was defined as temperature exceeding 100.4° F. on two or more occasions during any consecutive 48 hour period exclusive of the first 24 hours following operation. Thirty-four per cent of the patients fulfilled this criterion. The cut edge of the vaginal cuff was routinely swabbed immediately following removal of the uterus during operation and yielded a culture positive for E. coli in 37 instances. Twenty per cent of the patients produced a positive urine culture. Significantly, only 5 per cent of the patients developed a urinary infection as the result of 24 hour drainage through a self-retention catheter. Fifteen per cent had asymptomatic clinically unrecognized bladder infections present before operation. This study demonstrates the importance of routine culture of the vaginal cuff at abdominal hysterectomy.

Conglutination of the labia minora in the presence of normal endogenous estrogen levels: an exception to the rule.

A case report of conglutination of the labia minora in a 20 year-old nulliparous woman who had normal estrogen levels. The case is exceptional in that the condition is usually associated with estrogen deficiency and the adhesions are expected to separate spontaneously when endogenous estrogen is naturally secreted. The patient was successfully treated by sharp dissection. This rare occurrence is likely due to a high degree of scarring by the initial inflammatory process which estrogen alone could not overcome.

All vulvar lesions should be biopsied: Basal cell carcinoma—an example of the futility of diagnosis by gross appearance

Gross polymorphism of basal cell carcinoma of the vulva as well as all vulvar lesions calls for biopsy of any suspicious areas in that region. In most instances local excision is satisfactory treatment. Close follow-up is necessary as the recurrence rate is approximately 20 per cent even when the lesion is completely resected.

Physiologic jaundice of the newborn. Relation to maternal serum and amniotic fluid alpha-fetoprotein.

Maternal serum and amniotic fluid alpha-fetoprotein determinations were made at or near term. There appears to be a correlation between elevated levels of alpha-fetoprotein and physiologic jaundice of the newborn. It is suggested that this assay might be used as an index of fetal liver maturity when considering elective cesarean section or induction.

Fetal‐Maternal Hemorrhage after Amniocentesis: Incidence, Degree and Ramifications

A review of the literature indicates a small but significant incidence of fetal‐maternal hemorrhage following amniocentesis. In these studies, consideration has not been given to the frequency with which erythrocytes containing hemoglobin F are to be found in the maternal circulation in the absence of amniocentesis. In this investigation, Kleihauer‐Betke analysis was carried out before and after amniocentesis. This study confirms previous reports that spontaneous fetal‐maternal hemorrhage is not uncommon during normal intrauterine gestation and that amniocentesis is probably only an occasional cause of fetal‐maternal hemorrhage. This impression is based on the findings that most Kleihauer‐positive maternal blood samples after amniocentesis were also positive before amniocentesis. In spite of these findings, and since Rh‐immune serum globulin is apparently harmless to the fetus and mother, its use is still advocated in nonsensitized Rh‐negative mothers after amniocentesis.

Stilbestrol Therapy in Pregnancy

IN 1948 Smith reported increased fetal salvage after the administration of diethylstilbestrol (DES) during pregmancy. He suggested that estrogens were necessary for the utilization of human chorionic gonadotrophin by the placenta in the production of progesterone and other steroids. Recommendation was made that therapy begin at the 6th to 7th week from the last menstrual period and that doses be graduated from 5 mg. to 125 mg. daily to the end of the 35th week. Approximately 5% of the ward obstetric patients who delivered at the Boston Lying-in Hospital between 1946 and 1951 received DES because of high risk pregnancy. Perhaps this is the mitigating factor which accounts for the disproportionate number of vaginal tumors observed in women aged 14 through 22 years, born between 1946 and 1951, as reported by Herbst et al. and Greenwald et al. in 1971. Furthermore, 60 cases of vaginal tumors seemingly related to maternal DES therapy have since been reported to the Registry for Adenocarcinoma of the Genital Tract in Young Women at the Massachusetts General Hospital as of November 16, 1971.