Paavo Vara

Prostaglandin-oxytocin abortion: A clinical trial on intra-amniotic prostaglandin F2α in combination with intravenous oxytocin

A clinical trial on the induction of midtrimester abortions was carried out on 57 women treated by intraamniotic administration of prostaglandin (PG) F2α, either alone or in combination with intravenous oxytocin. The mean induction-abortion interval was significantly shorter in the 36 women who received both PGF2α and oxytocin (17.3 hrs) than in the 21 women treated with PGF2α alone (26.6 hrs). Eighty-one per cent of the women in the PG-oxytocin group, and 43 % of the controls aborted within 24 hours, and abortion was achieved in 97 % and 86 % of the cases respectively, within 48 hours. Multigravid women aborted more quickly than primigravidae. The mean abortifacient dose of PGF2α was significantly reduced (from 36.6 to 26.4 mg, p < 0.001) by the simultaneous use of intravenous oxytocin. Our results suggest that oxytocin improves the clinical management of PGF2α-induced abortions.

Extra-amniotic prostaglandin-oxytocin abortion: comparison with the intra-amniotic method.

Abstract Four different regimens for the termination of mid-trimester pregnancies with prostaglandin F 2α (PGF 2α ) were studied in 126 women. The best results were achieved using intra-amniotic PGF 2α in combination with a high dose of intravenous oxytocin. The abortifacient effect of extra-amniotic PGF 2α was slightly but not significantly improved by the concomitant use of either extra-amniotic or intravenous oxytocin. Signs of infection were more common in the patients treated with the extra-amniotic catheter than in those whose medication was given by puncture through the abdominal wall.

THE PLACE OF CAESAREAN SECTION IN OBSTETRICS TODAY

Intr ad zcct ion Caesarean section (C. s.) was originally performed on the dead woman to remove the child from the uterus through an incision in the abdominal wall. This form of the operation has been known since ancient times among both civilized and primitive peoples. Its modern application goes back to FranCois Rousset (1581, quoted from Stubler, 1951) who was the first to weigh the indications for the operation with the view of saving the life of both mother and child. Since then, the obstetrician has to face the same difficult problem as the surgeon before operating upon a patient, i. e. the decision upon the question whether the operation is indicated or not. The great progress which has been made in

On Fetal Electrocardiography

Determining the condition of a fetus protected by its mother’s body during pregnancy naturally involves considerable difficulty. Practically the only methods hitherto available have been palpation and stethoscopic examination. For this reason it is clear that efforts should have been made to use an examining machine as sensitive as the electrocardiograph for this purpose. Already three years after EINTHOVEN had invented the electrocardiograph, CRAMER published in 1906 a report on the first successful examination of fetal heart action with the aid of an electrocardiographic tracing. He reported having in a number of cases successfully made visible the ))Andeutungen des Elektrokardiogramms des Fotuso, by coupling abdomen-vagina or abdomen-rectum. These results he had achieved on patients in the final month of pregnancy. After the fetal ecg had once been recorded, new investigations have frequently been conducted. Considered in advance, answers to the following questions should be sought with the aid of the ecg:

Beobachtungen über das “Frühaufstehen” nach gynäkologischen Operationen bezw. Entbindungen

Eine allgemeine Betrachtung der medicinischen Forschungsmethoden zeigt, dass alte bewahrte Massnahmen stets wiederauferstehen und aufs neue in Gebrauch kommen. Die Methode, die Patientinnen nach Entbindungen und gynakologischen Operationen friihzeitig wieder aufstehen zu lassen, bildet keineswegs eine Ausnahme dieser Beobachtung. Das ergiebt ohne weiteres ein Blick in die Fachliteratur. Seit den 90 er Jahren des vorigen Jahrhunderts hat man nahezu periodisch und mit jedem Jahrzehnt mehr seine Aufmerksamkeit auf die fragliche Methode gerichtet, die sich als eine wirksame Prophylaxe gegenuber Thrombosen und Embolien erwies. Diejenigen, welche das ))Friihaufstehenu nach Entbindungen zuerst erprobten, waren GOODEL 1881 in Amerika und zu gleicher Zeit KUSTNER in Deutschland; nach gynakologischen Operafionen wurde es 1899 von RIES in Amerika und etwa ein Jahrzehnt spater von HARTOG und KRONIG in Deutschland geubt. Mehrere Anhanger schlossen sich sofort dieser Methode an, die freilich auch viele Gegner fand. Betrachten wir die gewohnlichen und am meisten wiederholten Behauptungen, die fur, und dann diejenigen, welche gegen ein ofriihzeitiges Aufsteheno sprechen! )>Friihaufstehem nach Entbindungen sehen seine Anhanger BUMM, GAUSS, HEIMAN, HOEHNE, MAYER, v. VELITZ u. a. als vorteilhaft einwirkend an: auf den Allgemeinzustand der Patientin,

Low back pain and gynaecological disease.

Cynaecological disease frequently receives priority in considering tlie cause of low back pain in women. F o r this reason tlie majority of these patients go to see a gynaecologist for relief of their complaints. The gynaecologist is then faced with the problem as to the cause of the pain and has to analyse the complaints i n the light of the patient’s subjective description and his own ohject ive findings. However, pain is often tlie only symptom wliicli serves ;is a connecting link between the su1)jectivity of the patient and the objectivity of tlie physician. Clianges differing from tlie normal in tlie female genitals o r elsewtiere in the lurnlmr spine and pelvic girdle revealed by objective examination a re not always sufficient in themselves to provide a r e l i a l k explanation as t o tlie cause of the pain and tlie complaint. In particular, low back [)ail1 is a very diffuse syndrome, and the gynaecologist needs tlie assistance of an o r thoped i s t to elucidate tlie underlying causes.

EFFECT OF DIFFERENT ANESTHESIA METHODS ON EOSINOPENIC RESPONSE TO SURGICAL STRESS

Using the reaction of circulating eosinophils as an indicator, the authors studied the influence of three different anesthesia meshods (closed system, open ether and spinal anesthesia) on the surgical stress as a function of the duration of operation. The material studied consisted of 435 gynecological cases.

Clinical Investigations on the O2 and CO2 Content and the Alkali Reserve of Arterial and Venous Blood Specifically in Connection with Operations

Summary.The present study covers clinical investigations made for the purpose of observing the changes which take place in connection with anaesthesia and surgical operation in the O2 and CO2 content and the alkali reserve of arterial and venous blood, and in the fluid balance. The investigations have been carried out at Womens Clinic II and Surgical Clinic II of Helsinki University. They were commenced already in the spring of 1941 but were interrupted by the war, being thereupon resumed in the summer of 1945. Attention was then paid also to the fluid balance by determining the chlorides and proteins of the plasma. Altogether 55 surgical patients were examined and laparotomy was performed in the majority of cases. Forty-three were female and 12 male, the ages varying between 17 and 62 years. Twenty-one medical disease patients suffering from severe pulmonary, cardiac and blood diseases served as material for comparison. In addition, blood tests were also taken from 50 healthy persons in order to obtain ...