Second-look laparoscopy in ovarian cancer.

Forty-six patients with epithelial ovarian cancer previously treated with surgery, chemotherapy or external radiation underwent second-look laparoscopy to evaluate management. Twenty of the patients had positive laparoscopic findings and were not subjected to further laparotomy. The frequency of positive findings was related to the stage of the disease. Laparoscopic examination revealed no evidence of cancer in the remaining 26 patients. Three of the patients in this group were found to have additional disease at subsequent laparotomy. The laparoscopic procedures were not associated with major complications. Although second-look laparoscopy cannot replace repeat laparotomy, it does have a role in the follow-up of patients with ovarian cancer.

Selective survival of only the healthy fetus following prenatal diagnosis of thalassaemia major in binovular twin gestation.

Selective feticide is the procedure of choice when, in twin binovular pregnancy, only one of the fetuses is shown to be affected. As the probabilities for this condition are almost 1:2 when the genetic disease is due to homozygosity for two autosomal recessive genes, the problem is expected to occur frequently among the ever increasing number of couples seeking prenatal diagnosis of thalassaemia and the haemoglobinopathies. The present report is the first case of this condition and the ninth in the overall medical literature.

Psychosocial stress and its relation to obstetrical complications.

A Greek adaptation of the Schedule of Recent Experience of Holmes and Rahe was employed to study the relationship of psychosocial stress to symptoms during pregnancy, obstetric complications, family planning and breast feeding. An initial experiment with 130 pregnant women in the third trimester indicated that psychosocial stress was not related to education, whether they were from Athens or the provinces, nor age. The second experiment with 103 mothers 3 or 4 days after delivery indicated that high psychosocial stress is related to increased symptom scores during pregnancy and to obstetric complications. Symptoms were not related to obstetric complications, nor were family planning nor breast feeding. Psychosocial stress was also related to family planning and also to whether or not the mother breast fed.

PIP: The relationship between psychosocial stress, the occurrence of various symptoms during pregnancy, the occurrence of obstetric complications, family planning, and breast feeding intentions was assessed for 103 maternity patients at the Alexandra Maternity Hospital in Athens, Greece. A modified version of the Holmes and Rake Schedule of Recent Experience was used to measure the level of psychosocial stress. The modified instrument consisted of 48 stressogenic life events. Respondents were asked to identify the events they had experienced, to rate the level of stress induced by the event on a 0-100 scale, and to specify if the event occurred 0-6 months, 7-12 months, or 13-25 months prior to delivery. Respondents were also presented with a list of symptoms and asked to identify those they experienced during pregnancy, to rate the severity of the symptoms, and to identify the trimester in which they occurred. Subjective psychosocial stress scores and symptom scores were then calculated for each respondent. A gynecologist reviewed the delivery records of each woman and classified the delivery in respect to obstetric complications as either normal or abnormal. Respondents were also asked if the birth was the result of an unplanned or planned pregnancy and if they intended to breast feed their infant. Questionnaires were administered 3-4 days following delivery. Pearson product-moment correlation, analysis of variance, and chi-square techniques were used to analyze the data. The level of psychosocial stress experienced during the 6-month period prior to delivery was positively associated with the occurrence of obstetric complications; however, the level of stress experienced more than 6 months prior to delivery was not. The most common stressogenic events reported by women who had obstetric complications were 1) high anxiety about the health status of the fetus, 2) death of a loved one, 3) arguments with parents or spouse, 4) a sharp decline in income, and 5) job-related problems of spouse. The level of psychosocial stress was also positively related to occurrence of symptoms during pregnancy, and 25% of the variation in symptom scores was explained by differences in psychosocial stress levels. Symptom scores increased with each trimester of pregnancy, but were not associated with the occurrence of obstetric complications. Women who planned their pregnancies, in contrast to those who did not, had significantly lower psychosocial stress and symptom scores; however, the occurrence of obstetric complications was not significantly related to either planned or unplanned pregnancy. Similarly, women who intended to breast feed, compared with those who did not, had significantly lower psychoosocial stress and symptom scores, but breast feeding intention was not significantly related to the occurrence of obstetric complications. Women who planned to breast feed and women who planned their pregnancy tended to be younger than women who did not plan to breast feed and women who did not plan their pregnancy.

The use of 15-methylated derivative of prostaglandin F2a for the therapeutic termination of pregnancy and management of late fetal death.

The administration of 15-me-PGF 2a for the therapeutic termination of pregnancy and management of intrauterine death of the embryo during the second and third trimester of pregnancy was studied in 92 patients. Of these, 52 came because of intrauterine death with an average gestational age of 28.7 weeks while the rest came for therapeutic termination of pregnancy with an average gestational age of 21 weeks. Successful abortion was achieved in 90 patients. The mean abortion induction time was 7.3 hours for patients with intrauterine death and 12.6 hours for the patients who came for therapeutic termination. The results and complications of the intramuscular administration of the 15-me-PFG2a are analysed in the present work.

Treatment of chronic prostatitis by consecutive per os administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin.

Fifty men with cytologically confirmed chronic prostatitis were treated for 3 months by consecutive p.o. administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin. The subjective symptoms, palpatory findings, secretory capacity of the accessory genital glands (values of acid phosphatase and fructose in the seminal plasma) were evaluated. The cytologic findings from the expressed prostatic fluid and semen analysis before and after the treatment were also studied. Approximately 60% of the patients were cured of the subjective symptoms. The palpatory findings disappeared in 50% of the cases. The cytologic findings became normal in 70% of the patients (inflammatory cells less than 25/HPF). The secretory function of the prostate and the seminal vesicles was improved in 50% and 25%, respectively, of the patients, and the quantitative and qualitative motility and viability of the spermatozoa after treatment were significantly enhanced.

Prenatal diagnosis of hemoglobinopathies in twin pregnancies by double simultaneous fetoscopy.

A new technique for sampling fetal blood in twin pregnancies using two fetoscopes simultaneously is described. Two fetoscopes were inserted, one after the other, into both amniotic cavities and fetal blood samples were obtained from either the chorionic plate vessels or the umbilical cord insertion area. The observation of the bright tip of the second fetoscope behind the septum using the first fetoscope assured the successful entry of the two fetoscopes into the two different amniotic sacs. This technique was performed on 15 out of 17 patients. In all patients the fetuses were at risk of beta-thalassemia major. Sampling was successful in all cases. Double simultaneous fetoscopy seems to be a safe and accurate technique without technical problems or complications. The simultaneous use of two fetoscopes opens new possibilities in intrauterine fetal surgery and research.

Zinc, cobalt and selenium concentrations in the premature and full-term newborn eye.

Zinc, cobalt and selenium concentrations were determined in tunics, vitreous and lens of the eyes of 17 infants who died during the neonatal period. Significantly higher concentrations of the measured elements were found in the vitreous. The tunics contained more zinc and cobalt than the lens, while the latter contained more selenium.

Evaluation of diagnostic fetoscopy.

The authors evaluate the efficacy and safety of fetoscopy on a series of 510 patients in which the procedure was carried out between the 18th and 20th week of gestation in order to obtain a suitable fetal blood sample for prenatal genetic diagnosis; the whole pregnancy could be completely followed up in them. The complication rate was low (1.7%) when the first attempt of fetoscopy was successful, but rose dramatically up to 17.9% on repeated attempts: however, they only amounted to 7.8% of all cases. The results of their study lead the authors to propose fetoscopy as a powerful, accurate and safe addition to the presently available diagnostic methods, provided it is performed by well trained fetoscopists, under aseptic conditions and local anaesthesia.

Cardiovascular birth defects and antenatal exposure to female sex hormones.

The etiological correlations of congenital heart diseases to antenatal exposure of pregnant women to sex hormones were studied retrospectively. Of a total of 15,535 women who delivered between the years 1975-1977, 91 had babies with congenital heart disease (frequency 5.80/00). From these babies 11 were born to 559 mothers who had taken during pregnancy hormones of the estrogen-progesterone type (frequency 190/00). The remaining 80 babies were born to 14,976 mothers who had not taken such hormones (frequency 50/00). The main reason for having been given hormones were: bleeding of the first trimester in 80%, and the pregnancy test in 20%. Both groups of mothers had the same possibility for being affected by factors causing congenital heart diseases. An attempt is made to correlate the structure of the hormones given, the cause and time of the administration, the outcome of the newborn, and the type of heart disease.

Bacteriologic aspects of pelvic inflammatory disease in gynecologic patients.

The bacteriology of acute pelvic inflammatory disease (PID) was studied in 65 women. Endometrial, endocervical and vaginal cuff cultures were taken. In some cases blood cultures and cultures from the cul-de-sac or pelvic abscess were also obtained. Mixed organisms (aerobes and anaerobes) were the most common isolates from the endometrial, endocervical or vaginal cuff cultures, present in 40%. Neiseria gonorrhoeae was isolated in 8 (12.30%) endocervical specimens. Anaerobes were the most common bacteria recovered from cul-de-sac aspirates, pelvic abscesses and blood cultures. The combination of gentamicin, penicillin and metronidazole was the most common antibiotic scheme used. However, other antibiotics as cefoxitin and clindamycin were also used according to the sensitivity test. These data support the polymicrobial etiology of the disease and suggest: (1) the high incidence of anaerobic or mixed infections, and (2) the relatively low incidence of gonococcus in the studied cases.

The transition in frequency of Y-chromatin in males during early infancy.

The frequency of Y-positive lymphocytes in blood smears at delivery and during early infancy was assessed to determine the exact time at which it is similar to the frequency in adults. It was found that at day 0 of life the frequency of Y-chromatin-positive cells was 26.6 +/- 13.2% (mean +/- SD); subsequently, it increased gradually to 41.2 +/- 12.2%, 49.7 +/- 9.7% and 55.4 +/- 5.2% at the 30th day, the end of the 3rd month and the end of the 4 month of life, respectively (Fig. 1). The frequency in adult males was 57.8 +/- 5.8%. This is the first time that the same infant population has been investigated in all the stages of a study.

Clindamycin phosphate in the treatment of endometritis due to anaerobic bacteria.

Treatment of endometritis due to anaerobic pathogens demands early isolation and identification of the offending pathogen by the appropriate culture and optimum use of antibiotics according to the sensitivity test. Clindamycin phosphate has been used as a highly active antibiotic against both gram-positive and gram-negative anaerobic pathogens, including bacteroides fragilis. The concentration of clindamycin phosphate in blood from the uterus was tested in 30 women after administration of one single dose (600 mg) intramuscularly. The levels of clindamycin in the above-mentioned tests state how samples were compared with the minimal inhibitory concentration of the offending anaerobic pathogens in cases of endometritis.

Bacterial contamination of the cervix and premature rupture of membranes.

The endocervical flora was examined in 32 women with premature rupture of membranes (PROM). Sixty-six pregnant women served as controls. Ten patients with PROM who later developed chorioamnionitis were also included in the study. Samples for culturing were obtained from the endocervix on admission and at delivery and later from the fetal surface of the placenta. Blood for culturing was also taken in cases of chorioamnionitis. The total number of bacteria in the endocervix and placenta was higher in patients with PROM. Anaerobes were the most common, except for the fetal surface of the placenta, where aerobes were found in greater numbers. Cultures of blood from women with chorioamnionitis were positive in seven cases. These findings suggest that the high incidence of pathogenic or potentially pathogenic cervical bacteria in pregnancy is related to chorioamnionitis and PROM.