Richard Jaffe

Failure of methotrexate treatment for term placenta percreta

Placenta percreta is a severe condition associated with maternal morbidity and mortality even when surgery is performed electively. Methotrexate has been suggested as a possible treatment modality for adherent placenta to avoid catastrophic surgery. The purpose of this report is to present a case where the placenta was left in situ to avoid cystectomy at the time of cesarean section, with subsequent failure of treatment with methotrexate.

Color Doppler imaging and in vivo assessment of the anatomy and physiology of the early uteroplacental circulation

OBJECTIVEnTo evaluate in vivo the anatomy and physiology of the normal early uteroplacental circulation.nnnDESIGNnForty-six women were included, all of whom continued their pregnancy into the second trimester. Color Doppler was used to identify peritrophoblastic flow, and spectral Doppler was used to analyze waveforms obtained from the different segments of the uteroplacental circulation.nnnRESULTSnFlow was detected in the spiral arteries of the peritrophoblastic region in all patients. Flow was detected within the intervillous space in only one case.nnnCONCLUSIONSnThis study demonstrated that color Doppler imaging can be employed as an in vivo means of studying the uteroplacental circulation. The study confirmed the in vitro findings that trophoblastic invasion of the decidual spiral arteries occurs at 5 to 6 weeks gestation. The study also confirmed the fact that there is no noticeable blood flow within the intervillous space during most of the first trimester of a normal pregnancy. Both of these findings may serve to protect the early gestation from the forces of arterial blood flow.

MCSCF potential energy surface for photodissociation of formaldehyde

The ground state potential energy surface for the dissociation of formaldehyde H2CO→H2+CO is calculated with the ab initio MCSCF method with an extended (4–31G) basis set. The location, barrier height, and force constants of the transition state are determined and the normal coordinate analysis is carried out. The calculated barrier height is 4.5 eV. Based on the calculated quantities, the detailed mechanism of the photochemical dissociation is discussed.

Abinitio and semiempirical study of multiple surfaces and their analytic continuation for collinear F(2P3/2, 2P1/2)+H2→FH+H

The potential energy surfaces for the 2Π and 2Σ states in the collinear H2+F(2P3/2,1/2) →HF+H reaction have been calculated with ab initio restricted Hartree–Fock (GRHF) and GRHF–CI (configuration interaction) methods. The 2Π state in the CI calculations exhibits a well in the entrance valley. The effects of spin–orbit interaction have been examined in terms of a 2×2 secular equation in which the experimental spin–orbit coupling constant for the fluorine atom is used. GRHF calculations for complex values of nuclear coordinates are carried out to locate complex intersection points. Furthermore, two sets of semiempirical potential energy surfaces are constructed to simulate GRHF and GRHF–CI results. Dynamical implications of these surfaces are discussed in terms of complex intersections and nonadiabatic coupling constants.

Twin-twin transfusion with abrupt onset of microcephaly in the surviving recipient following spontaneous death of the donor twin

We describe a case in which twin-twin transfusion with fetal death of the donor at 23 weeks was complicated by suspected intracranial embolic insult of the surviving recipient twin. Dynamic transient intracranial ultrasonographic findings were noted with complete resolution by 28 weeks. Subsequent severe microcephaly of the survivor with no further growth of any of the cranial parameters beyond 25 weeks was thought to be a result of this very unusual pathophysiologic mechanism.

Calculations of potential energy surfaces in the complex plane. IV. Ab initio surfaces for H3

Ab initio LCAO‐MO‐CI calculations are reported for selected geometries of H3+ in the vicinity of the real‐valued avoided intersection and complex intersection. The complex energy difference between the two lowest singlet surfaces is compared to the corresponding DIM values. In addition, the effect of polarization functions in the basis set is investigated and atomic orbital electron populations for the complex CI wavefunction are determined.

Calculations of potential energy surfaces in the complex plane

Procedures are developed and tested for the numerical analytic continuation of the difference between two potential energy surfaces of the same symmetry in the vicinity of their complex-valued intersection. Rational fractions are used for curve-fitting ΔE as a function of either one or two independent, complex nuclear coordinates. The rational fractions are constructed from discrete values of ΔE(R, r) to exhibit the branch-point structure explicit in the complex square root function. For analytic continuation to values of the nuclear coordinates with small imaginary parts only real-valued input points are required. In order to analytically continue ΔE farther off the real-axis a few complex-valued input points must be used in addition to the real-valued data. The rational-fraction methods are tested for two systems : (a) the energy difference between the 3σ and 4σ states of HeH++ and (b) the energy difference between the two lowest singlet states of H3 + at collinear geometries. In both cases, the rationa...

Massive hydronephrosis mimicking theca lutein cysts in association with partial hydatidiform mole.

We present an unusual case of partial hydatidiform mole in which extensive, multiple cystic structures encompassing the entire right abdomen and pelvis, initially thought to represent theca lutein cysts, were subsequently shown to consist of massive unilateral right hydronephrosis. Percutaneous nephrostomy decompression bypassing the ureteropelvic obstruction revealed functional renal parenchyma.

Uterine Evaluation in Turner Syndrome: A Preliminary Study With Doppler Ultrasound

Background Since the advent of in vitro fertilization and donor ovum technology, patients with Turner syndrome, previously infertile due to ovarian failure, now have an opportunity to conceive and carry a pregnancy. This new opportunity has refocused attention on nonnal uterine growth and development in Turner syndrome. Prior studies of the uterus in Turner syndrome have utilized ultrasound measurement of the uterus to describe uterine characteristics and, in the absence of estrogen replacement therapy (ERT) or endogenous estrogen production, have found the uterine size to be almost unifonnly prepubertal irrespective of the age of the patient. No studies to date have assessed uterine blood flow by Doppler velocimetry in patients with Turner syndrome. Uterine blood flow is regulated by many factors but primarily by gonadal sex steroid hormones. In postmenopausal women on ERT a reduction in resistance to blood flow is seen. suggesting an increase in uterine perfusion with ERT. Whether this relationship is true in the patient with Turner syndrome is unknown. Methods We studied eleven patients with Turner syndrome by transabdominal pelvic ultrasound and evaluated, by Doppler velocimetty, the uterine artery pulsatility index (PI), calculated by (systolic – diastolic)/mean. Patients ranged in age from 5–17 (median 14). Pubertal development was assessed by Tanner staging, and height, weight and karyotype was recorded for all patients. Patients were placed on estrogen replacement therapy to initiate puberty, including type and dose of ERT, at the discretion of their physician. The ultrasonographer was blinded to the presence or absence of ERT. At the time of the first ultrasound, 6 patients were taking ERT, 2 on estrogen alone, 3 on cyclic estrogen/progestin (although all studies were performed on estrogen only day) and one was on an oral contraceptive. Mean duration of estrogen exposure was 23 months. One patient had spontaneous pubertal development and 4 patients had received no estrogen treatment and were Tanner I in development. At the time of ultrasound, uterine volume, cervix/fundus ratio and the presence of visible ovaries were also recorded. Results The mean uterine artery PI of patients with estrogen exposure was 2.21(±xa01.23) and the mean of the unexposed group was 3.99(±xa01.04). This suggests a trend toward decreased uterine artery resistance in the patients with estrogen exposure (pxa0=xa00.07 by Mann-Whitney test). The lowest PI was seen in the patient with spontaneous pubertal development. Uterine volume was significantly larger in the estrogen exposed group, 38.7xa0cm3 ±xa023.3 in the estrogen exposed and 1.32xa0cm3 ±xa00.9 in the non-exposed group. (pxa0=xa00.01 by Mann-Whitney test). Conclusion In the patient with Turner syndrome, estrogen exposure is associated with a corresponding increase in uterine volume and a trend toward decreased uterine artery resistance. Further study and continued prospective follow-up will indicate whether estrogen treatment in those patients studied prior to estrogen replacement is associated with similar changes.