David M. Farell

Fetal radioelectrocardiography: a new method of fetal electrocardiography: Preliminary report

Abstract Fetal radioelectrocardiography, a new approach to the science of fetal electrocardiography, has been introduced. The advantages of this system are as follows: 1. 1. Its accuracy is excellent (99.1 per cent). False negative results are rare. 2. 2. To date, no false positive results have been obtained. 3. 3. A high percentage of readable fetal complexes can be obtained. The significance of these complexes was discussed. 4. 4. This procedure can be used in all pregnant patients, with no special preparations, and at any location. 5. 5. The system is almost completely free of electrical interference. 6. 6. The wireless system enables remote recordings. Thus, only the transmitter need be moved to the patients room, whereas the receiver and recording apparatus remain stationary. Practical application of this new obstetric tool has been outlined. Additional work is in progress.

Cervical carcinoma in situ: Difficulties in differential diagnosis

Abstract 1. Existing confusion regarding carcinoma in situ of the cervix and reasons for delay in clarification of the problem are discussed. 2. Our findings among 4,152 cervical biopsy specimens, obtained between 1930 and 1946 and previously reported, are briefly summarized, with particular emphasis on 9 invasive carcinomas with previous biopsy specimens, among which 1 true intraepithelial carcinoma was found. 3. The findings among 4,187 cervical biopsy specimens obtained between 1946 and 1952 are presented, with particular emphasis on 6 cases diagnosed “carcinoma in situ” and followed by repeat cervical biopsies without treatment other than the repeat biopsies, which, to date, showed the lesions to be reversible. 4. The etiology of benign carcinomimetic cervical lesions is discussed and the difficulties of differential diagnosis between them and genuine incipient carcinoma are emphasized. 5. Attention is directed to the extreme atypism of such lesions and the suggestion is made that it is not pathognomonic of incipient carcinoma but represents a nonspecific reaction of normal cells to injurious influences in the environs. 6. The desirability of a policy of watchful waiting in the doubtful case, particularly if the patient is young, and the comparative safety of such a policy are stressed.

Observation of fetal heart rate during cesarean section

Abstract We have reported observations of FHR during 20 cesarean sections. Prior to the sections, no fetus showed any sign of fetal distress and all were vertex presentations. Spinal anesthesia with atropine sulphate premedication was used in all cases. All newborns were apparently healthy. Seven of the 20 FHRs (35 per cent) showed no variations throughout the cesarean sections. In all of the remaining 13 cases (65 per cent) fetal bradycardia occurred during at least one part of the procedure. During the cesarean sections the fetal bradycardia was observed (1) in association with maternal hypotension, (2) occurring at or during skin incision or elsewhere during the surgical procedure, and (3) at delivery of the fetal head. From these observations, it appears that fetal bradycardia may occur during cesarean sections under spinal anesthesia with the delivery of an apparently healthy newborn. Explanations for these observations were offered.

End results in adenocarcinoma of the endometrium managed by preoperative irradiation

Abstract 1. 1. Table XV presents a summary of the 5 year results in 297 patients seen during the 34 years, 1921 to 1954. 2. 2. Irradiation, especially with intrauterine radium, has played a prominent part in the therapy. In operable cases it has been used primarily to devitalize the carcinoma and thereby prevent manipulative spread and local recurrence. 3. 3. The preferred method of treatment has been intrauterine radium followed in 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Sixty per cent of the patients were treated by less satisfactory methods, usually because the carcinoma was advanced or the patient was a poor operative risk.

End results in the treatment of carcinoma of the cervix

Abstract 1. 1. An analysis of a series of 293 patients with carcinoma of the cervix observed on the Gynecological Ward Service, Jefferson Medical College Hospital, from Sept. 1, 1921, to Sept. 1, 1936, of whom 277 were treated, is presented, based upon a follow-up study of 97.2 per cent of the patients seen and of 97.8 per cent of those treated. 2. 2. An absolute present-day salvage rate of 12.9 per cent, a relative present-day salvage rate of 13.7 per cent, and a relative five-year salvage rate of 23.1 per cent are presented. These are contrasted with rates of 19.2 per cent, 20.5 per cent, and 25.3 per cent respectively, published in 1936; and with rates of 14.2 per cent, 15.0 per cent, and 20.7 per cent respectively, published in 1931. 3. 3. Various phases of the analysis are discussed and compared with the previous reports, together with the exhibition of pertinent data.

Myoma of the vagina; case report.

Abstract Approximately 220 cases of myoma of the vagina have been reported. A case of a 45-year-old white woman with a myoma of the vagina, not associated with uterine myoma, has been reported.

The noise-free fetal electrocardiogram recorded from the maternal abdomen

Abstract Although reports have appeared describing the usefulness of the fetal complex in the diagnosis of fetal distress, the true value of the complex has been obscured by our inability to obtain readable FECGs. This is especially true of tracings recorded from the maternal abdomen. This article presents a simple, easily reproducible technique to extract the fetal complex recorded from the maternal abdomen from its background noise using averaging techniques with small, on-line table model computers. Three readouts from different fetuses are presented, demonstrating in each a clear biphasic fetal QRS complex and positive P and T waves.

OBSERVATION OF FETAL HEART RATE DURING CESAREAN SECTION

F E 1‘ A L H E A R T rate (FHR) during labor and vaginal delivery continues to be of great interest to fetal electrocardiographers. However, only a few case reports appear in the literature describing the FHR during abdominal delivery.‘, 2 While FHR patterns associated with the vaginal birth of a healthy infant are becoming better understood, little is really known of the FHR during the birth of a healthy infant by cesarean section. This paper is intended to shed some light on this aspect of obstetrics.