Carbon isotope fractionation in the Fischer-tropsch synthesis and in meteorites.

Carbon dioxide and organic compounds made by a Fischer-Tropsch reaction at 400 degrees K show a kinetic isotope fractionation of 50 to 100 per mil, similar to that observed in carbonaceous chondrites. This result supports the view that organic compounds in meteorites were produced by catalytic reactions between carbon monoxide and hydrogen in the solar nebula.

Granulocyte-macrophage colonies in cultures of human fetal liver cells: morphologic and ultrastructural analysis of proliferation and differentiation.

Fetal liver cells from 6-12-week-old human fetuses were cultured in soft agar to study growth patterns of the granulocyte-macrophage colony forming cells (CFU(c)) and to characterize the cellular components of these colonies by morphologic, cytochemical and ultrastructural methods. Liver cell suspensions prepared from 31 fetuses obtained by vaginal interruptions of pregnancies, were seeded in soft agar over feeder layers of normal human leukocytes. At all gestational ages examined, agar colony numbers ranged from 44 +/- 15 to 89 +/- 44/2 x 10(5) cells seeded. Colony frequencies, size and gross morphology closely resembled those derived from adult human marrow. Morphologic, cytochemical and ultrastructural examinations showed that 92% of the colonies were granulocytic with incomplete maturation, as found in adult human marrow colonies. Density fractionation of the cells produced a low density cellular fraction which gave a 3- to 5-fold improved cloning efficiency. This study shows that human fetal livers of 6-12 weeks gestational age contain CFU(c) comparable to that found in adult marrow in their frequency, size, density and dependence on colony stimulating factor, and which differentiate mainly into mature or immature granulocytes. It is suggested that the lack of granulopoiesis in vivo in the early human fetal liver is probably not related to CFU(c) deficiency or defective differentiation. An alternative explanation involving impaired regulatory mechanism(s) should be sought.

Endocervical-type epithelium in endometrial carcinoma: a report of 10 cases with emphasis on histochemical methods for differential diagnosis.

A review of the histologic material from 100 patients with endometrial carcinoma revealed 10 cases in which endocervical-type epithelium constituted an integral component of endometrial adenocarcinoma. In nine of these, the endocervical epithelium was focal while in one patient, reported in detail, the curetted endometrial carcinoma presented as an almost pure endocervical-type lesion. In most instances, the endocervical epithelium was papillary and mature, but areas of tufting, pseudostratification and atypism were also evident. Endocervical-type epithelium in endometrial cancers was more common in curettings than in hysterectomy specimens probably because of its superficial location within the tumor. The endocervical nature of these components, which are most likely of metaplastic origin, was evident on light and electron microscopy. Histochemical stains established the similarities of the cytoplasmic mucins of these cells to that of normal endocervix and well-differentiated endocervical adenocarcinoma and emphasized the dissimilarities to the mucin content of papillary, secretory and clear-cell endometrial carcinoma. Thus, awareness of this type of lesion, application of strict histologic criteria and use of histochemical stains make it possible to reach the correct diagnosis in most cases, even in those in which the endocervical-type epithelium composes the major portion of curettings from an endometrial adenocarcinoma.

Second-breech presentation in twins--a possible adaptive measure to promote fetal growth.

Two hundred eighty-three longitudinally lying twin pairs were evaluated for the possible etiology of breech presentation in twins. Breech-breech pairs were delivered at a significantly earlier gestational age (P less than .02), because of significantly more deliveries (P less than .04) between 30-32 weeks, compared with vertex-second twins. Nevertheless, breech-breech pairs attained similar or larger birth weights when compared with other combinations. Discordant-second twins were found five times more frequently in breech-second pairs when twin A was in the vertex presentation. It is possible that breech-breech pairs reach a critical utero-fetal proportion earlier, resulting in earlier labor. Alternatively, twins may arrange in second-breech presentations as an adaptive measure to promote growth. We recommend special care for persistent breech-breech presentations diagnosed at the beginning of the third trimester.

The efficacy of intraamniotic steroids for induction of labor.

Labor induction in humans by the injection of 18 mg of betamethasone (Celestone) into the amniotic sac was investigated in a group of 19 pregnant women. Eight of the cases were high-risk pregnancies of 36-39 weeks' gestation, and 11 were normal pregnancies of 40-42 weeks' gestation. A group of 19 women at similar stages of pregnancy served as a control group. The criterion for the efficacy of the technique was the onset of labor or rupture of the membranes within 72 hours of the injection. Contrary to other reports, it was concluded that the technique is ineffective since no significant difference was found between the experimental and control groups.

Partial moles: a clinicopathologic study of 25 cases.

This study is based on a review of all moles diagnosed at the Kaplan Hospital in Israel from 1968 to 1977. Histologic reevaluation revealed that of a total of 72 moles, 47 (65%) were complete and 25 (35%) partial. In contrast to complete moles, about one third of the partial moles showed fetal parts. An analysis of the patient records showed smaller uteri, less vaginal bleeding, absence of severe vomiting, lower gonadotropin levels, and normal follow-up in patients with partial moles as compared with those who had complete moles. These results indicate that the partial mole is a distinct clinicopathologic entity that can be suspected by the clinician and confirmed by the pathologist on morphologic grounds, even in the absence of cytogenetic analysis.

The problem of the older primipara.

The obstetric data relating to 98 older primiparas (OP) (0.21% of all deliveries) are compared with 100 randomly chosen older multiparas (OM) and 100 young primiparas (YP). Notable differences observed were a higher incidence of toxemia and a greater incidence of uterine myomata in the OP group. No difference was seen in the incidences of diabetes, cardiac disease, and essential hypertension. There was a greater number of preterm deliveries. The frequencies of induction of labor, vacuum extraction, and cesarean section were much greater in the OP group. No difference in postnatal course was detected among the 3 groups. No significant increase in perinatal morbidity was observed, but the incidences of prematurity and perinatal mortality were higher. It seems that the attending obstetrician is much quicker to decide to terminate pregnancy or labor ithe OP group. Except for the need for special attention to prematurity and perinatal mortality, the OP group is not at high risk.

Effect of intrauterine device on histology of endometrium.

Endometrial biopsies were performed in asymptomatic IUD wearers on specific days of the menstrual cycle, and the histologic features were compared to those expected for the day of the cycle. Normal women who had endometrial biopsies performed as part of a sterility workup were used as controls. Endometrial asynchronism (defined as histologic delay or advance of 3 days or more) was observed in 33.5% of 113 biopsies performed on 79 women with IUD'S; 30% showed a delay in endometrial development during the secretory phase. Our findings give further support to those who claim that contraception with the IUD is not achieved through one single process but that a number of mechanisms are possible. Endometrial asynchronism may constitute one of such modes of action.

Growth discordancy in appropriate for gestational age, term twins.

We compared 14 term (37 weeks or more), discordant (15% or more birth weight difference), but not growth-retarded (2500 g or larger) twin pairs with 28 randomly selected term and appropriate for gestational age twin pairs without discordancy. The comparison of the two subgroups showed no significant difference in maternal age, parity, gestational age, incidence of maternal hypertension, or perinatal outcome. It is suggested that discordancy is not a risk factor when the twin pair has reached term and the lighter twin weighs at least 2500 g.

Characterization of the growth-discordant twin.

A computer-assisted analysis of perinatal variables was undertaken in order to characterize the growth-discordant twin. We studied 124 twin pairs grouped at four degrees of discordancy: over 5, 10, 15, and 20% birth weight difference, using the larger twin as 100%. Twins with birth weight discrepancy below these figures were considered concordant. Highly discordant second twins showed significantly lower birth weight, gestational age, and Apgar scores, and prolonged neonatal hospitalization, as compared with discordant first twins. Complex presentations and a higher cesarean section rate characterize discordant first and concordant twins. It is suggested that a 15% birth weight discordancy be used as the safety limit for birth weight disparity. We also recommend special attention when discordancy seems to increase, especially if the discordant is the second twin.

Vaginal delivery of the second twin in breech presentation.

The obstetric performance of 39 vertex-breech twin-pairs was compared with that of 48 vertex-vertex pairs. No difference was found between the two groups in maternal age, parity, gestational age, birth weight, and Apgar scores. The second twin in breech presentation had a higher incidence of very low birth-weight (less than 1500 g), but of borderline significance (P = .05), and a significantly (P less than .03) longer hospitalization period. The cesarean section rate was 7.7 and 10.4% for the breech and vertex second twin, respectively. In our view, breech presentation of the second twin is not an indication for cesarean section.

Teratogenicity of progestogens given during the first trimester of pregnancy.

Possible teratogenic effects of exogenous progestational agents given during early pregnancy were investigated by a controlled historic prospective study of 2754 infants born to mothers who had bled during the first trimester of pregnancy. The study group consisted of 1608 newborns whose mothers had been treated with progestogens (mostly medroxyprogesterone acetate) beginning in the first trimester. The control group comprised 1146 infants of untreated mothers. All newborns were subjected to thorough examination during the first days of life, with special attention to detection of various malformations classified according to the different anatomic systems. No significant difference was found between the treated and the control groups with respect to malformations in any of the systems examined. The overall rate of malformations was 120 per 1000 in the study group and 123.9 per 1000 in the control group. Major malformations occurred at rates of 63.4 and 71.5 per 1000, respectively. The study thus fails to demonstrate an increase in teratogenicity after administration of gestagens during the first trimester of pregnancy.

Prenatally diagnosed blocked atrial premature beats.

A case of persistent severe bradycardia in labor, diagnosed as blocked atrial premature beats, is presented. Simultaneous recording of fetal heart rate (FHR) and fetal electrocardiogram (FECG) during labor established an accurate diagnosis of an innocent fetal sinus bradycardia and differentiated it from fetal distress. This method should be applied in all cases of persistent fetal dysrhythmia, in order to differentiate it from hypoxic distress, and thus enable the obstetrician to avoid unnecessary cesarean sections.

The prevalence of cervicitis, reserve cell hyperplasia, squamous metaplasia, and cervical dysplasia in Jewish women.

The prevalence of cervicitis, reserve cell hyperplasia, squamous metaplasia, and dysplasia was studied in Jewish women and compared to that reported elsewhere in non-Jewish populations. The study was based on a histologic review of 250 women whose cervices were clinically either normal or presented with minor changes, and of 50 cases of squamous cell carcinoma. The findings indicate that the prevalence of the above-mentioned histologic features in the 2 groups of Jewish women is similar to that observed in comparable groups of non-Jews. It thus appears that in a majority of Jewish women the histologic spectrum leading to cervical cancer unexplicably stops at the dysplastic stage. On the other hand, the results of this study may possibly cast doubt on the well-documented evidence establishing dysplasia as a pre-cancerous lesion. For further elucidation of these problems cytologic studies in matched Jewish and non-Jewish populations will be carried out.

Management of labor with umbilical cord prolapse: a 5-year study.

Fifty-one cases of cord prolapse, in which delivery was not imminent and the fetus was still alive, were managed by filling the bladder with 500-700 mL of saline and by intravenous ritodrine. Delivery was by cesarean section as soon as possible. Among the cases so managed, there were no perinatal deaths. The mean 5-minute Apgar score was 9.5, and in only three cases was it less than 7. In eight cases, fetal distress continued after treatment, as compared with 33 cases before this type of treatment started (P less than .001); no difference was found in the outcome between neonates weighing less than or greater than 2500 g.

Constant ovulation on the side of an occluded tube treated with human menopausal gonadotropin.

We have presented the case of a woman with unilateral occlusion of a tube ovulated permanently on the same side. The other ovary and tube were intact. To overcome this problem, we gave full menotropic treatment to induce super-ovulation, and the patient became pregnant in the second treatment cycle. We think medical treatment should be attempted before paradoxical oophorectomy is contemplated in women with unilateral occlusion who cannot become pregnant.

Adult respiratory distress syndrome complicating ovarian hyperstimulation syndrome.

A rare case of OHSS complicated by an ARDS from which the patient recovered after appropriate treatment is presented. Pulmonary capillary leakage induced by prostaglandin release, hypoalbuminemia, and shift of dextran 40 macromolecules to the intraalveolar space is considered the most probable reason for this complication.

The growth discordant twin.

The study of growth discordancy in twin gestation has gathered great momentum in recent years. Divergent intertwin growth is believed to be a direct result of the process of twinning and of the inability of the uterine environment to provide for the increased demand of multiple fetuses. The smaller twin faces increased risk of perinatal mortality and morbidity as well as reduced physical and mental development in later life. The advent of ultrasonography enabled a fairly accurate prediction of growth disparity. Although extensive investigative efforts have clarified many questions regarding divergent twin growth, the question how to manage such pregnancies remains to be answered. The present article is a review of the literature concerning the clinical aspects of growth discordant twins.

Non-aggressive management of post-date pregnancies.

A non-aggressive approach to the management of post-date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less. Dates had been established with certainty in each case. In half of the patients (the study group) no time limit was imposed on the pregnancy, but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following: fetal movement count recorded daily by the mother, an oxytocin challenge test, and amnioscopy. The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score. In the 78 control patients labor was induced surgically on day 294, even if the pelvic score was low. In the study group, labor started spontaneously in 52 patients; labor was induced in 17 women after they showed an elevated pelvic score, in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed. There were 7 cesarean sections in the study group compared with 16 in the control group (P less than 0.05). The average duration of labor was 6.7 h in the study group, compared with 9.4 h in the control (P less than 0.01). There was no significant difference between the two groups with regard to meconium staining during labor, pathologic fetal heart rate, or the 5 min Apgar score. In the study group there was one neonatal death as a result of severe congenital heart disease, and in the control group one infant died due to asphyxia. It is concluded that conservative management of prolonged pregnancies, with close supervision, gives better results than routine induction of labor at 42 wk. The importance of the pelvic score as an indication for induction is stressed. A protocol has been developed which can be used in cases of uncertain dates as well.

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report.

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.