W.Norman Thornton

The effects of magnesium therapy on the duration of labor.

Abstract Magnesium is an accepted drug in the management of toxemia of pregnancy, and is employed by many physicians as the anticonvulsant agent of choice in the therapy of this commonly encountered gestational disease. Many modes of administration and variable dosage schedules have been evolved over the past half century, ranging from small quantities given orally to relatively large amounts introduced by the parenteral route. In a recent study conducted at the University of Virginia Hospital, 5 it was suggested that prompt, rapidly attained, and effective magnesium blood levels (7 to 8 mEq. per liter) could best be effected by introducing this agent intravenously. Therefore, during the last 30 months, pre-eclamptic and eclamptic patients admitted to the Obstetric and Gynecologic Service of the University Hospital have received magnesium intravenously in high dosages. Clinical observations carried out in our labor and delivery suites have, however, given the impression that the intravenous administration of magnesium sulfate, in sufficient concentration, results in a prolongation of labor. Inasmuch as the commonly utilized sedative drugs morphine, meperidine, and phenobarbital used in the therapy of toxemia have been seemingly exonerated of a direct uterine depressant activity, 14 and since the only departure from the customary therapeutic regimen during the past 30 months from that employed previously was the elevation of the serum magnesium level, it appeared probable that, if labor were in truth prolonged in these patients, the magnesium ion was depressant to the human myometrium during labor. It was in an attempt to clarify this point that the present study was undertaken.

Ectopic pregnancy: Current clinical trends

During the 16 year period ending in November, 1978, 191 cases of ectopic pregnancy were managed at the University of Virginia Hospital. The overall incidence was 1/126 deliveries but during the last 3 years of the study the incidence was 1/60 deliveries. Only 56 patients have had a subsequent conception. Thirteen have had a recurrent ectopic implantation. Only 36 women (23.7% of those available for follow-up) have had subsequent term pregnancies. Ectopic pregnancy continues to be a major gynecologic problem and the potential for subsequent fertility is poor.

Thrombotic thrombocytopenic purpura associated with pregnancy.

Thrombotic thrombocytopenic purpura (TTP), a disorder of unknown etiology, appears to be a syndrome often associated with infectious, vascular, or autoimmune diseases. When it occurs in pregnancy, TTP can mimic other gestational complications. Two patients with TTP associated with pregnancy form the basis of this report. On patient is the second person known to have survived longer than 2 years after concurrent TTP and pregnancy. This patient had underlying glomerulonephritis and was treated with corticosteroids and heparin. The other patient, in whom an underlying disease process was not identified, was treated unsuccessfully with most of the recommended therapeutic modalities. Patients with concurrent TTP and pregnancy have the same prognosis as nonpregnant patient with TTP. Both groups have a prolonged survival rate of only 10 per cent. Primary treatment should consist of corticosteroids and inhibitors of platelet aggregation. If a rapid response does not occur, splenectomy is indicated. Care must be taken to recognize the pregnancy complicated by TTP, a circumstance which appears to occur more frequently than past reports have indicated.

Effect of toxemia therapy on uterine dynamics

Abstract Effect on uterine dynamics of magnesium sulfate, hydralazine hydrochloride, and cryptenamine acetates was evaluated by in vitro and in vivo techniques. Magnesium sulfate depressed myometrial activity in vitro. Hydralazine hydrochloride decreased the rate and increased the amplitude of contraction of human myometrial strips. In concentrations of 6 to 8 mEq. per liter of maternal serum, magnesium reduced the uterine activity of 7 pre-eclamptic patients in active spontaneous labor. The effect of each agent on myometrial and hemodynamic variables was measured in 3 pregnant rhesus monkeys during both normotensive and induced hypertensive states. Serum magnesium concentrations of 6 to 8 mEq. per liter resulted in a reduction of arterial blood pressure, a greater decrease in extrinsic myometrial resistance, and an increase in uterine artery blood flow. Intravenous administration of hydralazine hydrochloride in quantities sufficient to produce a statistically significant decrease in arterial blood pressure did not significantly alter uterine artery blood flow or average intra-amniotic pressure. Responses to cryptenamine acetates were inconclusive.

Late urinary system complications following radical hysterectomy for carcinoma of the cervix

Abstract Urinary system complications which are incompatible with life are common complications of untreated carcinoma of the cervix as recently emphasized by necropsy studies of Henriksen. 1 This study 1 and others 2, 3, 12 have pointed out the urological complications and the importance of urological follow-up studies in those patients with carcinoma of the cervix treated by irradiation therapy. With the revival of the surgical approach to the problem of cervical malignancy, urinary system complications remain one of the hazards of treatment with resultant urinary fistulas and their sequelae as reported by Meigs 4 and Thomas and associates. 5 This study is a report of late urological complications in a small group of patients with carcinoma of the cervix treated by radical operation. It is the purpose of this study to present the various types of postoperative urinary system complications as seen in our clinic.

Pelvic exenteration in the treatment of advanced malignancy of the vulva

Abstract Twelve patients with extensive epidermoid carcinoma of the vulva were selected from a group of 72 women with this malignancy for partial or total exenteration. This extended operative procedure was utilized in 10 patients as the primary treatment and in two patients after radical one-stage vulvectomy with bilateral inguinal and retroperitoneal lymphadenectomy had failed to control the malignancy. The one-stage extended procedure is described. Fifteen immediate and six late complications occurred. There was one postoperative death and four additional patients died as a result of persistent malignancy. Seven patients were without evidence of tumor seven months to 9.5 years after the primary operation.

Pelvic lymphadenectomy for carcinoma of the uterine cervix

T H E pelvic lymph nodes have been the subject of extensive discussion in regard to both the therapy and the prognosis of carcinoma of the uterine cervix. There has been prolonged controversy concerning the relative merits of irradiation versus operation in controlling metastatic disease in the pelvic lymph nodes, and there has been a persistent belief among some advocates of surgery that irradiation is incapable of destroying metastatic cancer cells in the primary lymphatic drainage of the uterine cervix. These surgical enthusiasts have indicated that the hope of improving the 5 year survival rate in patients who already have lymph node metastases is a major argument in favor of surgery. In order properly to consider this controversy, it is essential that there be a valid appraisal of the incidence of node metastases in each stage of this disease, yet the reported incidence of metastatic disease in the pelvic lymph nodes in association with cervical cancer would seem to vary significantly (Table I). Perhaps the most frequentIy quoted figures are those of Me&,” who reported a 17.9 per cent incidence of positive

Sarcoma of the uterus, a clinical study

Abstract 1. 1. Twenty-four cases of sarcoma of the uterus, including two cases of sarcoma botryoides in children, occurring in twenty-four years at the University of Virginia Hospital are presented. 2. 2. Four patients (18 per cent) received intracavity irradiation more than ten years prior to the diagnosis of sarcoma. 3. 3. The diagnosis of sarcoma was established by diagnostic curettage in three patients and suggested in a fourth. 4. 4. The five-year survival rate for sarcoma in adults was 8 per cent. 5. 5. One child with sarcoma botryoides is alive, without recurrence, three and one-half years following x-ray therapy.

Repair of vaginal prolapse after hysterectomy

Forty-one women with primary or recurrent prolapse of the vagina following either vaginal or abdominal hysterectomy were treated with a vaginal operation. The retroperitoneal approach of utilization of the perirectal fascia to support the vault of the vagina is described and illustrated. This technique may also be used in selected patients to prevent this complication after vaginal hysterectomy and repair.

Effects of anesthetic and sedative agents commonly employed in obstetric practice on isolated human uterine muscle

Abstract 1. 1. An attempt to assay the effects of commonly employed anesthetic and sedative agents on human uterine muscle tissues is described. 2. 2. All of the inhalation anesthetics tested were found to be markedly depressant to gravid and nongravid uterine muscle activity in vitro, with the single exception of trichloroethylene. 3. 3. Morphine, scopolamine, Demerol, atropine, and phenobarbital produced no significant effect on the activity and tonus of uterine muscle samples obtained from both nongravid and gravid uteri. 4. 4. Nembutal was found to be without marked effect on tissues from nongravid uteri, but to possess a depressant action on samples from the gravid uterus when in sufficiently high concentration. 5. 5. Magnesium sulfate depressed contractility and lowered tonus in muscle strips from both nongravid and gravid uteri.