George Blinick

Pregnancy in narcotics addicts treated by medical withdrawal: The methadone Detoxification Program

Abstract The impact of narcotics addiction on the individual and the community is manifold and deep. Study has been made of 300 pregnant addicts voluntarily treated with medical withdrawal on methadone in the Detoxification Program. In 100 consecutive deliveries of these patients there were increased incidences of low birth weights, meconium, and breech presentations. Other problems with the newborns were not significantly increased. Maternal complications were few and included a high rate of positive results in serologic tests for syphilis.

Pregnancy and menstrual function in narcotics addicts treated with methadone: The Methadone Maintenance Treatment Program

Abstract Chronic opiate addiction has been associated with amenorrhea, anovulation, and infertility. Methadone, a synthetic narcotic, has been given daily to 95 addicted women who formerly used heroin. Twelve women were in the menopause or had had hysterectomy. Of the remaining 83 premenopausal women, all but one resumed regular menstruation. Thirteen pregnancies were seen, of which 8 were conceived on high levels of methadone, and in 5 methadone therapy was started after previous heroin addiction. All the pregnant women were maintained on methadone, and no effect of the drug on the pregnancies has been demonstrated.

Variations in birth cries of newborn infants from narcotic-addicted and normal mothers

Abstract Sound spectrographs were performed on the birth cries of 369 neonates. Thirty-one were neonates born to drug-addicted mothers. A schema for the classifications of infant vocalization differentiating normal and abnormal spectrograms is presented. There was a significant statistical increase in abnormal voice spectrogram to babies born of addicted mothers.

The infrequency of pelvic endometriosis in negro women

Abstract Pelvic endometriosis is infrequently seen on the gynecologic service at Harlem Hospital which is almost entirely composed of Negro women. The recognized incidence was 0.1 per cent. Uterine adenomyosis is more common but was found in only 1.14 per cent of laparotomies.

Effect of sulfonamide cream on the bacterial flora of the infected vagina and cervix

Abstract 1. 1. The incidence of bacteria found in the vaginal and cervical secretions of patients with “nonspecific leucorrhea,” excluding those with trichomonas, monilia, or gonorrheal infection, is presented. Twenty-seven microorganisms were isolated, of which the most frequent were staphylococcus albus; alpha, beta, and gamma streptococci, diphtheroids, and colon bacilli. The variety of organisms isolated in any single patient varied from three to twelve, with an average of seven. Anaerobic streptococci were relatively rare. 2. 2. A multiple sulfonamide cream is effective in suppressing the coccal organisms and ineffectual in eradicating diphtheroids and coliform species from vaginal and cervical secretions. When used in ten patients after cauterization, it gave striking diminution in postcautery discharge and bleeding. In thirty-five other patients, fifteen noted relief of discharge following three weeks of daily therapy with the cream alone. No improvement of the cervical erosions could be demonstrated within this period.

Treatment of advanced inoperable ovarian carcinoma with thio-tepa

Abstract Chemotherapy with thio-tepa has been used in the treatment of 105 patients with advanced ovarian carcinoma. Individual cases have shown striking response to the chemotherapy and more than half the patients have experienced some remission. Significant side effects, such as bone marrow depression, have been noted in almost half the patients. Thio-tepa appears to be an effective, though far from ideal, agent in the treatment of advanced ovarian carcinoma.

Salmonella Infection in Gynecology

Summary 1. Two cases of Salmonella infection of the tubes and/or ovaries are reported. Three additional cases were found in the literature. 2. In one of the two cases presented, a positive stool culture of Salmonella is reported for the first time. 3. The route of infection has not been definitely ascertained, although blood stream infection (possibly to previously infected tubes) is not unlikely. 4. The positive agglutination tests indicate that the Salmonella bacilli are of etiologic significance in the causation of pelvic infection and are not accidental contaminants. 5. The manifestations of such infections are not clinically distinctive. Certain identification can be made only by bacteriologic and immunologic methods. 6. The treatment would not seem to differ from that of salpingitis caused by other bacterial organisms such as the gonococci.

Community prenatal care: An “integrated” approach

Abstract Meeting the need for improved prenatal care has led to innovative approaches to clinic organization and management. Delivery of optimal prenatal care is based on availability of services and acceptability to patients. Greater involvement of the obstetrician is dependent on improving the system to facilitate his services and exploit his capabilities. Modest expenditures can transform an institutional setting into an inviting, comfortable locus where expectant mothers will not be impeded from seeking care. The difficulties of clinic attendance for pregnant women of low socioeconomic order are largely related to time factors. These factors, to a great degree, can be overcome by a system of “integrated” clinics, where the traditional separation of obstetrics and gynecology is broken down. The advantages of the “integrated” clinics include greater availability of prenatal service, ending of self-referral with wasted physician-patient encounters, elimination of duplicate examinations for the patient, and better patient-utilization of services. This improved utilization leads to more time for establishing rapport and lessening anxiety, more time for delivering prenatal education, and more time for discovering and treating medical problems. A prenatal care program using these principles has demonstrated improved patient acceptability with a low rate of failed appointments, high incidence of first-trimester registration and increased numbers of clinic visits.

The office management of leukorrhea.

Abstract 1. 1. A clinical classification and differential diagnosis of the causes of vaginal discharge are presented to simplify the office management of leukorrhea. 2. 2. The list of diagnoses is rapidly narrowed down by means of the history, physical examination and laboratory findings. 3. 3. The most important single diagnostic test is the microscopic examination of the vaginal discharge in a saline drop. The wet smear will make the diagnosis in three of the most common causes of troublesome leukorrhea, namely, vaginitis due to trichomonas, monilia and senile atrophy. 4. 4. Specific office therapy is discussed with each diagnosis. 5. 5. A table for the differential diagnosis and therapy of leukorrhea is presented.

Abnormal vaginal bleeding

Abstract The office management of abnormal bleeding is greatly simplified by an orderly search for its cause—functional or organic. Many of the cases are readily managed in office practice by rational therapy, properly prescribed.