Edwin P. Peterson

Amniotic Fluid Embolism. An Analysis Of 40 Cases

Amniotic fluid embolism is increasing in relative importance as a cause of maternal mortality but may be amenable to promptly instituted therapy. To further establish the clinical characteristics associated with this obstetric emergency and to aid the clinician in identifying the high-risk patient, 40 examples of amniotic fluid embolism are analyzed with respect to clinical findings and to gross and histopathologic features. The salient clinical features related to amniotic fluid embolism are increased age and parity, premature placental separation, intrauterine fetal death, meconium contamination of amniotic fluid, and hypertonic labor. Special stains, particularly for mucin, revealed significant amounts of amniotic fluid debris in pulmonary vessels in all cases. Emboli organs other than the lungs were rarely observed and are thought to be of no clinical significance

Diagnostic considerations in virilization: iodomethyl-norcholesterol scanning in the localization of androgen secreting tumors.

Accurate localization of the source of androgen hypersecretion is critical to the appropriate surgical or medical management of women with virilization. Seven patients with virilization and hyperandrogenism of various causes were evaluated with the use of sequential studies: (1) testosterone stimulation and suppression tests; (2) computerized tomography (CT); (3) selective venous catheterization; and (4) 131 I-iodomethyl-norcholesterol (NP-59) scintigraphy. Comparison of the diagnostic accuracies of these localization studies with the ultimate diagnoses in this group of virilized women showed that: (1) endocrinologic suppression/stimulation studies are of limited value in tumor localization and helpful only in patients with steroidogenic enzyme deficiencies; (2) both selective catheterization and CT scanning may provide spurious localization data; and (3) NP-59 scintigraphy, by depicting both the anatomic localization and functional androgen hypersecretion, may provide the most significant localization data in the evaluation of patients with virilizing syndromes.

in vivo steroid biogenesis and metabolism in the human term placenta 2. in situ placental perfusion with cholesterol-7[alpha]-3H

Two human term placentas have been perfused with cholesterol-7α-3H. The perfusions were carried out at the time of elective repeat cesarean section and tubal ligation in term pregnancies. The major tritiated steroid identified was pregnenolone. It is suggested that the human placenta has the capacity to utilize circulating cholesterol at this stage of steroid biogenesis.

Early therapy for the incompetent cervix in patients with habitual abortion

From a thorough evaluation of 66 couples with habitual abortion (HA), 42 were found to have a widened uterine isthmus at hysterosalpingography (HSG) as their only abnormality. First trimester cervical effacement occurred in 90% of these patients. A combination of medical (progesterone [P]), and surgical (McDonald cerclage) begun during the first trimester resulted in successful term pregnancy in 35 of the 36 HA patients (97%) who were treated. The results of this study suggest that (1) functional cervical incompetence may play a major role in HA; (2) a widened uterine isthmus at HSG and first trimester cervical effacement are clinical signs that may define this group of HA; (3) early recognition and therapy for the incompetent cervix can interrupt the progression of events leading to the loss of an otherwise normally developing fetus; and (4) increased perinatal morbidity demands continuous antepartum assessment of fetoplacental integrity in these patients.

in vivo steroid biogenesis and metabolism in the human term placenta 2. in situ placental perfusion with cholesterol-7α-3H

Two human term placentas have been perfused with cholesterol-7α-3H. The perfusions were carried out at the time of elective repeat cesarean section and tubal ligation in term pregnancies. The major tritiated steroid identified was pregnenolone. It is suggested that the human placenta has the capacity to utilize circulating cholesterol at this stage of steroid biogenesis.

Diagnostic Considerations in Virilization: lodomethyl-Norcholesterol Scanning in the Localization of Androgen Secreting Tumors

Accurate localization of the source of androgen hypersecretion is critical to the appropriate surgical or medical management of women with virilization. Seven patients with virilization and hyperandrogenism of various causes were evaluated with the use of sequential studies: testosterone stimulation and suppression tests; computerized tomography (CT); selective venous catheterization; and 131I-iodomethyl-norcholesterol (NP-59) scintigraphy. Comparison of the diagnostic accuracies of these localization studies with the ultimate diagnoses in this group of virilized women showed that: endocrinologic suppression/stimulation studies are of limited value in tumor localization and helpful only in patients with steroidogenic enzyme deficiencies; both selective catheterization and CT scanning may provide spurious localization data; and NP-59 scintigraphy, by depicting both the anatomic localization and functional androgen hypersecretion, may provide the most significant localization data in the evaluation of patients with virilizing syndromes.

steroid biogenesis and metabolism in the human term placenta 2. placental perfusion with cholesterol-7α-3H

Two human term placentas have been perfused with cholesterol-7α-3H. The perfusions were carried out at the time of elective repeat cesarean section and tubal ligation in term pregnancies. The major tritiated steroid identified was pregnenolone. It is suggested that the human placenta has the capacity to utilize circulating cholesterol at this stage of steroid biogenesis.