Stephen R. Richards

Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy

This retrospective study compared 41 patients, 21 undergoing laparoscopic-assisted hysterectomy (LAVH) and 20 undergoing laparoscopic supracervical hysterectomy (LSH). The groups were comparable in age, weight, and previous abdominal surgeries. Surgical indications were similar with the exception of uterine carcinoma, which was always treated by LAVH. Vaginal repairs were more common in the LAVH group. The mean operative times, estimated blood losses, uterine weights, and hospital stays were all comparable for both groups. A potential advantage of LSH is that it requires less operative dissection of the bladder, ureter, bowel, and uterine artery. The possible disadvantage of LSH is the 10% frequency of cyclic stump bleeding. Larger studies with prolonged follow-up will be necessary to evaluate risks and benefits of the procedures.

Calcium levels in normal and hypertensive pregnant patients

Epidemiologic studies of hypertension in nonpregnant patients have suggested that abnormal calcium metabolism contributes to the genesis of hypertension. We have studied serum ionized calcium, total calcium, phosphorus, magnesium, total protein, and albumin in 16 normal pregnant women, 12 gravid patients with chronic hypertension, and 31 gravid patients with pregnancy-induced hypertension. In contradistinction to the reported difference in ionized calcium between nonpregnant normal and hypertensive patients, we have found no difference in serum ionized calcium between our groups.

Comparison of the harmonic scissors and endostapler in laparoscopic supracervical hysterectomy

We conducted a retrospective analysis of 29 consecutive patients undergoing laparoscopic supracervical hysterectomy to compare outcomes using the endostapler (15 women) versus harmonic scissors (14). Both instruments resulted in similar outcomes with regard to operating room time, blood loss, and hospital stay. The harmonic scissors have the advantage of decreasing patient cost compared with the stapler.

Serum carotene levels in female long-distance runners.

Hypercarotenemia has been associated with anorexia nervosa and hypothalamic amenorrhea. With the emergence of a spectrum of menstrual dysfunction, including anovulation in women runners, the hypothesis of hypothalamic amenorrhea in these patients has been formulated. Other authors have proposed exercise-associated amenorrhea to be distinct from hypothalamic amenorrhea based on endocrine profiles. Using carotene as an index test of hypothalamic amenorrhea, we have studied female long-distance runners (greater than 25 miles/week) and have found no difference in the carotene levels between ovulatory (midfollicular) and anovulatory runners. These data support other evidence that exercise-associated amenorrhea is distinct from hypothalamic amenorrhea.

Bloody tap amniocentesis: Discrimination between fetal and maternal blood by means of hemoglobin electrophoresis

Bloody amniotic fluid from amniocentesis or vaginal blood obtained in the late third trimester from 15 patients was analyzed for the presence of fetal blood by hemoglobin electrophoresis and Kleihauer-Betke tests. In addition, 15 experimentally formulated specimens were submitted for analysis. Where quantities were sufficient for parallel assay, the tests correlated 100%. Hemoglobin electrophoresis was an objective test for quantifying and accurately distinguishing the source of fetal-maternal bleeding.

Assessment of mammary lactogenic receptor changes in pregnant rabbits

Lactogenic receptor was purified from rabbit mammary tissue and used to generate an antiserum in goats. The purified lactogenic receptor material bound lactogenic hormones specifically and reversibly. Antiserum generated in a goat bound a labeled human growth hormone/receptor complex; this was displaced by nonlabeled solubilized receptor preparations. This was used as a radioimmunoassay and was able to detect 0.037 fmol of lactogenic receptor. The specificity of the radioimmunoassay for lactogenic receptor was supported by three lines of evidence; first, the ligand used in the radioimmunoassay was an iodine 125-labeled human growth hormone/receptor combination; therefore, only membrane protein with structural homology to the protein which bound 125I-labeled human growth hormone competed for binding to the antiserum; second, depletion of radioreceptor binding sites by affinity chromatography with ovine prolactin as the fixed ligand was detected; third, an increase in breast lactogenic receptor during pregnancy was detected by both radioreceptor assay and the radioimmunoassay. We found a progressive increase in lactogenic receptors by radioimmunoassay which corresponded to parallel increases by radioreceptor assay in rabbit mammary tissue during pregnancy.