Shraga Wexler

Asymptomatic bacteriuria in normal and high-risk pregnancy

A routine urine culture was performed in 1130 normal pregnant women and in 211 high-risk pregnancies (136 diabetics and 75 women with a previous urinary tract infection). Asymptomatic bacteriuria was found in 5.9% of the normal pregnancies, 12.5% among the diabetics and in 18.5% of the previous urinary tract infection patients. The higher incidence of a clinical urinary tract infection among patients with asymptomatic bacteriuria was found statistically significant (p less than 0.001) in all three groups. A high correlation was found between a negative urine culture in early pregnancy and the absence of development of cystitis and pyelonephritis in later pregnancy. The incidence of asymptomatic bacteriuria in normal pregnant women who developed cystitis later in pregnancy was 33.3% and in those developing pyelonephritis, 66%. In the two high-risk pregnancy groups, the incidence of asymptomatic bacteriuria among those developing clinical infection was even higher, 58.3 and 85.7%, respectively, among the diabetics, and 60 and 66.6% respectively, among the previous urinary tract infection patients.

The accuracy of hysterosalpingography versus laparoscopy in evaluation of infertile women.

Two hundred fifteen infertile women underwent hysterosalpingography (HSG) and laparoscopy. One hundred twenty‐eight patients had bilaterally patent tubes on hysterosalpingography. Thirty‐one percent of these women had pelvic adhesions diagnosed by laparoscopy. Eighty‐seven women had either occluded tubes or suspected pelvic adhesions on hysterosalpingography. Thirty‐nine percent of these women had patent tubes without any pelvic pathology on laparoscopy. Inaccurate diagnoses limit the value of hysterosalpingography in evaluation of tubal and peritubal pathology.

Prostaglandins—a role in Adhesion Formation an Experimental Study

The effect of intraperitoneal application of prostaglandins F2Alpha and E2 on adhesion formation was studied in the rat after traumatizing to the uterine serosa. Prostaglandins applied locally were found to increase intraperitoneal adhesion formation at the injury site, in comparison with controls. the effect of intraperitoneal application of prostaglandins F2Alpha and E2 on fibroblastic proliferation was examined in vitro, by fibroblastic cell culture of rat kidney, human kidney and human prepuce. No direct effect of prostaglandins on fibroblast proliferation could be demonstated. It is concluded that prostaglandins play an important role in the process of adhesion formation. This effect in not related to fibrobalast proliferation.

Calcium Antagonist Effect On Adhesion Formation

In view of the role of the calcium ion in the inflammatory process, the effect of Diltiazem — a calcium antagonist—on the formation of intraperitoneal adhesions was studied in rats after induced trauma to the uterine serosa. It was found that intraperitoneal application of diltiazem inhibited adhesion formation to some extent, whereas intramuscularly administered Diltiazem did not. A dual effect of calcium antagonists on the formation of adhesions is suggested.

Cervical Cerclage—Its Role in the Pregnant Anomalous Uterus

Twenty-nine cases of cervical incompetence were found among 98 women diagnosed as having a congenital uterine anomaly on hysterosalpingography, a high incidence of 30%. The highest incidence was found in the bicornuate uterus group--38%. The incidence of premature delivery and late abortion was higher in this group than in the rest of the patients with uterine anomalies (55% and 68%, vs. 45% and 32%). An obvious improvement in obstetrical performance was noted after cerclage. In the cervical incompetence group, term deliveries increased from 26% to 63%. Premature deliveries and late abortions dropped from 74% to 37%. Even in the patients with anomalous uterus without proven diagnosis of cervical incompetence, term deliveries increased from 64% to 96%, and pregnancies terminating prematurely dropped from 35.6% to 4%, following cerclage. No doubt exists as to the need for cerclage in cases of cervical incompetence. We also believe it should be performed prophylactically in cases of bicornuate uterus. The concept of routine prophylactic cerclage in all cases of uterine anomalies should be considered.

Pseudogestational Sac in Ectopic Pregnancy

Abstract. A case of tubal pregnancy demonstrated by sono‐graphy is presented. In addition to the true ectopic gestational sac, an intra‐uterine structure closely resembling a ge‐stational sac was detected simultaneously. Such a finding of a pseudogestational sac in the uterine cavity may mislead to the diagnosis of an intra‐uterine gestation. Thus, this sonographic finding is not sufficient to exclude the diagnosis of ectopic pregnancy. Clinicians should be aware of the possible finding of a pseudogestational sac in cases of ectopic pregnancy and the pathophysiological basis of this phenomenon is discussed.

Human chorionic gonadotropin in the ectopic gestation

The ectopic pregnancy is a relatively common condition in the south African black patients. The beta‐specific subunit radioimmunoassay for human chorionic gonadotrophin (HCG) was utilized in procuring information in our series of 30 patients. Levels of the hormone were significantly lower when compared to normal gestation of similar duration, never exceeding 2000 mIU/ml. The clearance rate of HCG following normal vaginal delivery was about 24 h and less variable than that of ectopic gestation. The half‐life clearance rate of HCG in the ectopics could be divided into three phases, suggestive of HCG compartmentalization. The possible buffering effect of this hormone in the maintenance of the receptor‐saturated pregnancy is discussed. The possibility that the HCG produced by the normal pregnancy is dissimilar to that of ectopic is speculated upon.