Kurt Benirschke

The incidence and prognostic implication of congenital absence of one umbilical artery

Abstract A consecutive series of 1,500 placentas has been examined with particular reference to the number of blood vessels in the umbilical cord. Complete absence of one umbilical artery occurred in 15 instances. In 7 infants there were some congenital abnormalities noted on examination; 3 were of major, character. One infant was stillborn. The anomaly occurred 3 times in one of twins. In a series of 100 twin placentas, one umbilical cord lacked one artery in 7 cases. The majority of these twins were monozygous. It is concluded that the observation of congenital lack of one umbilical artery at the time of delivery may be of significant benefit to some affected infants by drawing attention to the possible presence of correctible congenital anomalies in the baby.

Absent Umbilical Artery: A Review of 113 Cases

The umbilical cord normally contains two arteries and one vein embedded within Whartons jelly which is, in turn, enclosed by an epithelial membrane. Hyrtl (1870) described the absence of one of the umbilical arteries in 12 instances (four infants and eight placentae) of which only two infants were malformed, one suffering from spina bifida and both having cleft palates. He also noted that male infants were affected more often than female infants and that females lacking one umbilical artery were more frequently malformed and often anencephalic. Neither the observation of male dominance nor the higher incidence of abnormalities in females have subsequently been confirmed, although there is a high incidence of anencephalic deformity in the female infants. He collected a total of 58 cases from the literature to add to the 12 of his own. Browne (1925) reported a premature infant in whom the umbilical cord contained a single artery and the umbilical vein was replaced by a capillary network. Javert and Barton (1952) reported the results of the examination of 1,000 abortuses in which histological sections from 104 umbilical cords were examined. Only one was found to contain a single artery. Benirschke and Brown (1955) described a retrospective study of 55 infants in whom one artery was missing from the entire length of the umbilical cord. Of these 55 only 13 (24%) were considered to be normal children and of the remaining 42 there were 27 (64 %) who suffered from a wide range of congenital abnormalities, many of whom had multiple defects. Placental abnormalities were common (39 %). Little (1958) examined the umbilical cords of 1,200 consecutive deliveries, finding

Myocardial infarction in the perinatal period

Summary Two cases of myocardial infarction in the neonatal period are presented with autopsy findings. In one of these the cause of death was circulatory insufficiency due to necrosis and probable rupture of a papillary muscle. The second was associated with severe subendocardial fibroelastosis. A review of the pertinent literature is presented. Suggestions are made for further study of the entities discussed.

THE IMPLICATION OF CANDIDA ALBICANS INFECTION OF THE AMNIOTIC SAC

SINCE the appearance of the first recorded instance of Candida albicans infection of the amniotic sac in man (Benirschke and Raphael, 1958) our attention was drawn to the existence of another case in our files which is the subject of the present report.* The patient was a 30-year old white primipara who had been married two years. Apart from the usual childhood exanthemata and three mild attacks of “pneumonia” there were no significant previous illnesses. At the age of 17 a herniorrhaphy and at 24 tonsillectomy and adenoidectomy were performed. There was no history of any gynaecological disorders. The last menstrual period commenced on 12th July, 1944. When the patient was first seen in the antenatal clinic on 6th December, 1944, she had no complaints but on direct questioning admitted to occasional pain on micturition and slight painless white vaginal discharge. Physical examination revealed a healthy woman 5 feet 73 inches tall, weighing 145 pounds, with a blood pressure of 128/78 mm. Hg and with an adequate pelvis. No record of any untoward vaginal discharge was made at this time. Uterine size was consistent with the 21-week period of amenorrhoea. Auscultation of the foetal heart was not recorded. -----__~___ __ . . ~

Starch glove powders and granulomatous peritonitis

Abstract Granulomatous peritonitis from starch glove powder has been repeatedly demonstrated in laboratory animals and in man after operations. Two new cases are reported. The clinical picture is one of abdominal symptoms and fever with minimal positive physical or laboratory findings, occurring two to three weeks postoperatively. Paracentesis may be helpful in diagnosis if ascitic fluid is aspirated. At exploration there is often omental and peritoneal surface involvement with thickening, induration, and diffuse nodularity. The postoperative course is variable; ultimate recovery is the rule. Steroids have shown clinical promise in hastening recovery. Recognition of this syndrome by surgeon and pathologist is essential for proper management and avoidance of unnecessary operations. Ultimate prevention will come with the advent of a nonirritating glove lubricant. For the present, meticulous care in eliminating starch contact with the patient should minimize the development of starch granulomatous peritonitis.