Robert H. Messer

Teratogenesis and carcinogenesis in rat offspring after transplacental and transmammary exposure to diethylstilbestrol.

Abstract Transplacental and transmammary exposure of tat offspring to diethylstilbestrol (DES) was studied in regard to potential teratogenesis and carcinogenesis. Pregnant and/or lactating rats received DES in oil subcutaneously. In females so exposed, abnormal development of the urogenital sinus (hypospadias and urethrovaginal cloaca formation) occurred. In exposed male offspring, hypospadias, phallic hypoplasia, inhibition of growth and descent of testes, as well as abnormalities of Wolffian derivatives, were observed. In 20–40 per cent of DES-exposed female offspring, vaginal adenosis, endometrial squamous metaplasia, and genital malignancy were encountered. Two DES-exposed offspring had a vaginal squamous carcinoma, one had an endometrial adenocarcinoma, and one had an ovarian adenocarcinoma. Vaginal squamous carcinomas may have originated in foci of squamous metaplastic epithelium of vaginal adenosis. None of the control rats developed genital malignancy.

A survey of pregnancies complicated by decreased amniotic fluid

Four hundred seventy-one patients undergoing diagnostic ultrasonography were identified as having moderately decreased amniotic fluid or oligohydramnios, and 339 of these cases were reviewed. Ninety-two of the patients were excluded from further statistical analysis because their decreased fluid was attributed to rupture of the membranes only. Of the remaining patients there was a 7% neonatal malformation rate. Decreased amniotic fluid before 27 weeks of gestation was associated with a significantly poor outcome. Of all the live births, infants of patients with oligohydramnios had lower Apgar scores at 1 minute and 5 minutes than did infants of patients with moderately decreased amniotic fluid. Of cases of patients with decreased fluid, 10% involved fetal distress during labor and in 17% meconium was present. Decreased levels of fluid were associated with an increased rate of abdominal deliveries. Preeclampsia was present in 24.7% of patients with decreased fluid. There was no correlation between the quantitative fluid amounts and the severity of the disease. In view of normative data and clinical experience, these observations suggest that the diagnosis of decreased amniotic fluid on routine ultrasonography requires a fetal scan to rule out anomalies, close antepartum observation to detect complications that may arise in the pregnancy, and delivery under conditions that allow appropriate support and intervention on behalf of the fetus.

Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria

The antimicrobial potency of 4 per cent chlorhexidine gluconate was compared with that of 10 per cent povidone-iodine (1 per cent free iodine) on the vaginal bacteria of 150 premenopausal, non-pregnant women. From 30 of the women blood samples were taken before and at either 15, 30 or 60 minutes after vaginal cleansing with chlorhexidine for chlorhexidine analysis. Five minutes after applying either chlorhexidine or povidone-iodine almost 99 per cent of bacteria present on the lateral wall of the vagina were killed. Chlorhexidine was significantly more effective than povidone-iodine. Serosanguineous , mucoid or white-yellowish vaginal discharge did not alter the effectiveness of either antimicrobial agent. In contrast to povidone-iodine, vaginally applied chlorhexidine was not absorbed in measurable amounts (sensitivity of detection method: 0 X 1 mg/l) into the bloodstream. Chlorhexidine may therefore prove of value for treating vaginitis especially during pregnancy and also for combating microbes such as Group B streptococci which are potentially harmful to the newly-born child.

Seminal concentrations of total and ionized calcium from men with normal and decreased motility

In this study, sperm motility, velocity, and progression were compared with the total and Ca++ concentrations in the SF from men with normal and decreased motility (less than 60%). No significant difference in SF total calcium content was observed in men with normal and hypomotility. However, a statistically significant decrease in seminal Ca++ was observed in those men with decreased motility, when compared with that of men with normal motility.

The fourth-year medical school curriculum: Recommendations of the association of professors of gynecology and obstetrics and the council on resident education in obstetrics and gynecology

OBJECTIVES The Association of Professors of Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology have proposed a fourth-year medical school curriculum for a student interested in pursuing a residency in obstetrics and gynecology. STUDY DESIGN Faculty members and residents in North Carolina, Illinois, and Michigan were surveyed as to the ideal curriculum that they would recommend for fourth-year students. The committee members representing the Council on Resident Education in Obstetrics and Gynecology and the Association of Professors of Gynecology and Obstetrics then reviewed these surveys and proposed a final curriculum. RESULTS A core curriculum of general medicine as an acting internship, an intensive care unit rotation, neonatology, and emergency medicine was recommended. Additional courses strongly considered were ambulatory obstetrics-gynecology, acting internship in obstetrics-gynecology, endocrinology, and general surgery. CONCLUSION The committee recommends a curriculum that is broad and balanced in general medical education.

Resident attrition in obstetrics and gynecology

OBJECTIVE Our goal was to determine the rate of attrition from obstetrics and gynecology residency programs. STUDY DESIGN The Council on Resident Education in Obstetrics and Gynecology sent questionnaires to all 295 obstetrics and gynecology residency program directors in the United States and Canada. These programs represent 4306 postgraduate-year 1 through 4 (or 5) resident positions each year. The program directors were asked the number of residents who left voluntarily or were dismissed in a 2-year period and the reasons they left. RESULTS In a 2-year period 299 residents left or were dismissed (6.94% over 2 years, or 3.47% per year). Only 88 (1% per year) left specifically because they decided they preferred a different discipline. CONCLUSION The rate of attrition from obstetrics and gynecology residency programs is not excessively high.

Thymoma in pregnancy.

The natural history of slow, localized progression usually seen with thymomas seems to be transformed by pregnancy into one of rapid growth and distant metastatic spread. Five of the six previously reported cases had died of the malignancy within 6 months postpartum. The one previous long-term survivor died of treatment-induced complications. Two important questions remain unresolved: What is the risk of recurrence in the patient who has no residual disease at the time of conception? Approximately 50 per cent of female patients can anticipate having complete resection of their thymoma, and their recurrence risk is about 2 per cent. Potentially, there are many patients who have conceived and delivered after surgical therapy. Documentation of these case histories is needed for an accurate prediction of the true risk. Two of the cases within the present review fall within this category. The clinical course in these two patients is consistent with the natural history of the disease. One exhibited local recurrence and progression. The other patient died from sepsis, probably related to immunosuppression. Whether there is a cause and effect relationship between pregnancy and their recurrences is unknown. What is the risk to the patient who is first diagnosed while pregnant? The only survivor in this category was presented by Goldman. This patient underwent immediate therapeutic abortion following diagnosis. She had radiation therapy for invasive unresectable disease and subsequently delivered two term pregnancies, but died of postcesarean cardiac arrest. She had no evidence of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Evaluation of Zomepirac and APC with Codeine in the Treatment of Postpartum Episiotomy Pain

P OSTPARTUM episiotomy pain is usually most intense during the first 24 to 48 hours following delivery. Further, because the source of the pain is understood, its duration fairly predictable, and the population very homogeneous, postpartum pain provides a suitable model for the study of analgesics. Appropriate analgesic therapy for postpartum pain requires a rapid-acting, highly effective drug which allows the new mother to be free of pain but alert. Propoxyphene, which is frequently used in this clinical setting, has not been consistently effective in treating postpartum pain.14 While the narcotic-containing analgesics provide rapid and effective analgesia, pain relief is frequently accompanied by central nervous system effects which can impair alertness. In addition, with the trend toward shorter hospital stays after delivery, it is important that patients still experiencing pain

Maternal deaths in California from 1967 to 1971. A demonstration of the need for mortality review.

An evaluation of maternal mortality statistics in California from 1967-1971 has been performed. There has been a fall in the maternal mortality rate following the institution of a therapeutic abortion act. However, analysis of the data reveals that there was an increase in the deaths due to hemorrhage and sepsis. At this same time the maternal mortality study committee was discontinued. It is strongly felt that the data demonstrate the need for a continuing review of maternal deaths. A proposal is made to redesign the maternal mortality study committee so that it can fully meet the needs of the medical profession and the patient.

Embryonic/fetal growth following suckling-induced delay of implantation

In rats fertilized during the first or second day post partum (second consecutive pregnancy), suckling induces delay of implantation for 8 to 22 days. However, pregnancy is prolonged for only 3 to 17 days because accelerated embryonic and early fetal growth makes up 4 to 5 days of the implantation delay. After implantation, embryonic/fetal growth is accomplished within 11 to 12 days for a second consecutive pregnancy, whereas 16 days are required for first or second-spaced pregnancies. After weaning, increased function of the intestinal tract and liver is not needed anymore for mammary milk synthesis, and abundant nutrients can be shifted to the uteroplacental unit for rapid embryonic/fetal growth. Because the exponential curves for fetal growth are similar for first, second consecutive, and second-spaced pregnancies, it seems that, besides an increased supply of nutrients, an as yet unidentified maternal or a placentofetal factor(s) may play a role for embryonic/fetal growth.