Robert H. Barter

Intrauterine diagnosis and management of genetic defects

Abstract Amniotic fluid samples were obtained at early stages of pregnancy (56 before 20 weeks), when therapeutic termination of pregnancy could be performed should a genetic error be documented. Tissue culture growth was obtained in 62 of 74 samples with chromosomal analysis and established cell lines produced for genetic counseling. Sex chromatin was shown to be correlated with karyotypic and phenotypic sex when limited to the midgestational stage (10 to 34 weeks). A classification of the clinical conditions exhibiting a genetic risk of sufficient magnitude to warrant intrauterine analysis is given.

Neoplasms of dysgenetic gonads.

P R E v 1 0 Is classifications of patients who have had gonadal maldevelopmcnt have been based upon clinical findings, on morphology of the external genitals, on appearance of the gonads. and/or upon chromosomal constitution (karyotype) Reliance on one or the other of the above categories has resulted in an unsatisfactory system of classification which has persisted to the present time, despite the efforts of a few investigators to construct a standardized classification, or, at least, to dr\ise a more satisfactory terminology.‘-” I n order to better evaluatr the incidence and types of neoplasms associated with aberrant gonadal development, it is important to define some of the type‘s of ,qonadal maldevelopment that arc rerognixed: and to relate them to the classification proposed by other authors.

Some cytogenetic aspects of habitual abortion

Abstract An interdisciplinary study of the genetics in spontaneous abortion is described and the chromosomal complement of 35 first trimester abortions reported. In these cases it was found that early abortions have a higher incidence of chromosomal abnormalities (25 per cent below 13 weeks). A high number of the abnormal embryos (5 of 8) were found to be monosomic; two of these showed a double monosomy (X + autosome). Monosomic embryos aborted earlier and showed grossly abnormal morphology. A possible genetic explanation for the susceptibility of monosomic embryos toward abortion is advanced and the differences between two types of chromosomal anomalies is described.

HEMANGIOMAS IN PREGNANCY.

Washington, D. C. T H I s IS a report of a series of unusual experiences with cutaneous and mucosal hemangiomas which developed or became symptomatic during pregnancy. A hemangioma may be defined as a benign blood vessel tumor with its components somewhat apart from the general circulatory system. In pregnancy, these vascular tumors first appear during the middle trimester, gradually increase in size until term, and then usually regress in the puerperium. They may disappear completely after pregnancy or they remain permanently. In some instances, in which no treatment of the lesion had been instituted during a previous pregnancy, the tumor recurred or enlarged during subsequent pregnancies. There are many different classifications of hemangiomas. Some are clinical, while others are based on microscopic findings. Winer and Levin’ consider the acquired cutaneous hemangiomas of pregnancy to be eruptive angiomas. The involved capillaries may be arterial or venous. Arterial capillary angiomas may represent an overgrowth of an end artery of the skin or a thickened coiled artery of the cutis. The venous capillary angioma usually overlies a vein or venule which has become obstructed.

The prevention of prematurity in multiple pregnancy

Abstract It has been shown that in a patient who has a multiple pregnancy that early diagnosis, preferably by fetal electrocardiography followed by bed rest, will materially decrease the usually high incidence of prematurity in this condition. A plea is made for the increased use of fetal electrocardiography in all patients in whom the diagnosis of multiple pregnancy is suspected.

The use of hypothermic-hypotensive technique in fulminant toxemia of pregnancy☆

Abstract 1. 1. The definitive operative therapy of a small number of patients with acute toxemia of pregnancy has been carried out under a hypothermic-hypotensive technique. 2. 2. This technique was employed in an effort to make the surgical procedure necessary for the delivery safer for the mother and the fetus. 3. 3. An extremely pleasing but unpredicted result has been the excellent infant survival. 4. 4. The results to date with this ancillary technique in the treatment of acute toxemia of pregnancy seem to merit further consideration of its use.

The place of curettage in the diagnosis of carcinoma of the endometrium

In this series, 85 percent of the patients with carcinoma of the endometrium were found to be in the postmenopausal age group. The ultimate long-range effect of the increased use of estrogen therapy in older women who have not had hysterectomies will have to be closely watched from the standpoint of the development of endometrial carcinoma.

Cesarean Section: Past and Present

The original indication for the section mdash; which may or may not have figured in Caesars birth—was death of the mother at or close to term, and many centuries were to pass before the procedure could be performed with any expectation of salvaging either mother or child. The safety of the modern section lies not only in improved surgical technique but also in more complete knowledge of indications and timing.

Vaginal Hysterectomy with Anterior-Posterior Colporrhaphy

When the steps in its performance are carefully systematized, vaginal hysterectomy takes much less time, has lower anesthesia requirements, and entails less risk of complications than abdominal hysterectomy. It can be utilized in approximately 70% of women requiring hysterectomy, the author says, and is demonstrated here combined with anterior-posterior colporrhaphy in a parous patient with stress urinary incontinence.

Cesarean section anesthesia

Summary 1. A series of 1,563 cesarean sections has been presented. 2. Ninety-two per cent Of the patients were delivered under a balanced type of anesthesia utilizing a combination of intravenous and inhalation techniques. 3. This technique was generally acceptable to the patients as opposed to a large number of patients who are fearful of spinal and other forms of regional anesthesia. 4. There was no maternal mortality in this series. 5. The uncorrected perinatal mortality was as low in this series as in those reported by others. 6 6. The corrected perinatal mortality was less than 1 per cent.