Edward A. Banner

Variations in the peripheral circulation during pregnancy.

Abstract 1. A large series of determinations made with three different methods of evaluating peripheral blood flow demonstrate a progressive increase in the peripheral circulation during the development of normal pregnancy. 2. A definite mechanical effect of the enlarging gravid uterus on blood flow to the lower extremities was demonstrated coincidentally with the fixation of the fetal head deep in the maternal pelvis, and during gross fetal movements. 3. Within 6 to 10 weeks following delivery values observed in the peripheral circulation had returned to prepregnancy levels.

Tubal plastic surgery at the Mayo Clinic

Abstract Tuboplastic surgical procedures were performed on 75 infertile patients: salpingostomy in 32 patients, uterotubal implantation in 22 patients, end-to-end anastomosis in 2 patients, and a combination procedure in 19 patients. Eighteen patients became pregnant after operation; 10 after uterotubal implantation; 6 after salpingostomy, and 2 after end-to-end anastomosis or a combination of the abovementioned procedures. Of 54 patients studied in the immediate postoperative period, in 40 (74 per cent) there were patent tubes, while in only 28 of 51 patients (55 per cent) there were patent tubes at the time of follow-up examination (1 month to 10 years postoperatively).

Reconstructive operations for obstruction of the Fallopian tubes

W HAT might be termed the “renaissance ” in the surgical approach to infertility occurred during the years immediately preceding chemotherapy and antibiotic therapy. Before this time surgical procedures were attemptctl in various forms but, because of the high percentage of failures, were largely discarded. Little that is new has been added recently to the surgical approach, yet operations previously discarded are receiving approbation. I,itt,le in the present paper is new and much has been said by others in previous studies, albeit under different conditions. It was our endeavor to establish, after all else had failed, the eont.inuity of the lumen of the Fallopian tube. Obstructions encountered were variable and included pathologic processes from without as well as inflammatory eonclitions from within. The duration and extent of such processes necessarily influenced the outcome of our endeavors. Our study included only those patients presenting themselves for treatment after the year 1944.

Significance of Irregular Antibodies

In addition to antibodies normally found in human blood serum, irregular antibodies provoked by the introduction of erythrocyte antigens on isologous erythrocytes may also be present. The serum of every pregnant woman, regardless of her D type, should be examined for irregular antibodies, and if they are found, the physician should be aware that they may cause serious blood transfusion reactions or hemolytic disease of the newborn.

Cesarean Section: Changing Philosophy

A 15 year experience consisting of 643 cesarean sections has brought changes in philosophy reflected in liberalized application of abdominal delivery. Cesarean section should be considered in the following circumstances: breech presentation at term with doubtful pelvic capacity, nondelivery of a mature infant within 24 hours after rupture of the membranes, prolapse of the umbilical cord through an incompletely dilated cervix, desultory labor extending beyond 24 hours, erythroblastosis jeopardizing a viable fetus, and cervical carcinoma or maternal diabetes.

Criteria for Intervention in Rh Pregnancy

Spectrophotometric analysis of amniotic fluid has become an important guide to the timing of delivery of erythroblastotic infants. Intervention in the Rh pregnancy might well include intrauterine transfusion. At the Mayo Clinic this procedure is reserved for fetuses who, in the opinion of the Rh committee, have no chance of survival until maturity.

Effect of pregnancy on otosclerosis

Abstract The weight of evidence found in the literature and the results of this study lead us to believe that the effect of pregnancy upon the hearing loss due to clinical otosclerosis is significant and real, although variable and largely unpredictable. This effect has often been exaggerated, however. Hearing difficulties during pregnancy have been overlooked too frequently and often have been studied inadequately. Prompt detection and otologic evaluation will allow a complete audiometric follow-up of the earlier pregnancies in otosclerotic women. Patients afflicted with the more advanced stages of otosclerosis must be aided by the otologist in the choice between an operation and a hearing aid. The results in hearing restoration after the one-stage fenestration operation and the variety of procedures performed on the stapes (particularly stapedoplasty techniques) have afforded extraordinarily good results up to now. If the patient is not amenable to surgical treatment, she may benefit greatly from the use of a suitable hearing aid and from lip reading. Thus, with a properly selected device and instruction in the early adjustment period, many persons who have severe loss of hearing are able to lead useful, happy, and efficient lives. In light of past studies, the facts summarized on the foregoing pages, and the possibilities in otosurgery and aural rehabilitation, we find that much reassurance can be offered to otosclerotic women who are anticipating future gestations. Certainly one would find it most difficult to justify a therapeutic abortion or sterilization in cases of otosclerosis complicated by pregnancy.

The menopause and thereafter

The menopause is a fact of life for every woman, and how it affects her depends on her physiologic makeup and on her emotional health. An empathetic physician is a great help to the patient going through this stage of life. Whether to offer hormone replacement therapy is a question each physician in general or gynecologic practice must answer.

Tip-offs to ABO or Rh Disease

Hemolytic disease of the newborn is both treatable and preventable. The answers to questions asked a pregnant patient at her first visit may be a tip-off to a fetus in danger. Prenatal tests can identify the candidates for Rh immunization.

Testosterone propionate in carcinoma of the breast.

Testosterone propionate was administered regularly to patients with microscopically proved carcinoma of the breast. No evidence of permanent control of the disease was obtained. It is emphasized that treatment with hormones of this type should not be substituted for established procedures such as surgical measures or radiation.