Postoperative use of radioactive phosphorus in stage I ovarian carcinoma.

The addition of intraperitoneal colloidal radioactive chromic phosphorus following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy in women with Stage I ovarian cancer does not cause significant morbidity. Moreover, our preliminary results suggest that this regimen appears to increase the rate of local control of disease. In 21 unselected patients, there was 1 incident of small bowel obstruction. Fourteen of these patients have been followed for at least 1 1/2 years; all are alive without evidence of disease. These facts suggest that a national prospective study to investigate the efficacy of this treatment for Stage I ovarian cancer is warranted.

Vaginal delivery following previous cesarean section in 1983.

In 1983 the question whether or not to perform vaginal delivery following previous cesarean section is again presented to the obstetrical community. Data are presented on 778 patients managed during the decade January 1, 1973 to December 31, 1982. Four hundred seventy-six had scheduled repeat cesarean section on an elective basis. One hundred sixty-five experienced normal vaginal delivery. One hundred thirty-seven failed the attempt and were delivered by cesarean section. The group that delivered vaginally and scheduled elective cesarean section did well. However, in the failed attempt the problems were awesome regardless of indication or number of previous cesarean sections.

Carbon dioxide hysteroscopy.

Hysteroscopy was performed on 75 patients undergoing a dilatation and curettage for routine gynecologic problems. For the distetnion of the uterine cavity carbon dioxide was used and found to be an adequate medium to establish a pneumometra. It provided good visualization and was simple and safe to use for the hysteroscopic examination. Arterial blood-gas determinations revealed no change in the POI PCO2, and pH with carbon dioxide insufflation. There were no complications in this series. The advantages and applications of carbon dioxide hysteroscopy are outlined.

Coagulation studies during second-trimester abortions induced by PGF2alpha.

PIP: Extensive coagulation studies have been carried out on patients undergoing second trimester abortions induced by prostaglandin F2alpha. 30 patients with intraamniotic instillation of PGF2alpha have been studied and an additional 10 patients who were aborted by the extraovular route. Blood samples were obtained before onset of medication and at frequent intervals after beginning of drug administration as well as at the time of abortion. Intraamniotic administration of PGF2alpha resulted in increased levels of fibrinogen, platelets, factors 8 and 5, profibrinolysin, and fibrinolytic inhibitors during the 24 hour period after beginning of medication. The rise in the coagulation factors is suggestive of mild inflammatory process not associated with infection. Most of the indices have returned to normal levels shortly after expulsion of the fetus and placenta. Only 1 patient receiving PGF2alpha showed evidence of fibrin monomer formation as determined by protamine sulfate precipitation. Extraovular results were similar. The results have been compared to those obtained in this laboratory following hypertonic saline. With saline the results show a decrease in many factors, indicating disseminated intravascular coagulation. PGF2alpha may provide a safer method of second trimester abortion as far as the coagulation mechanism is concerned than does hypertonic saline.^ieng

The efficacy of intravaginal 15 methyl prostaglandin F2alpha methyl ester in first and second trimester abortion.

Fifteen methyl prostaglandin F2alpha methyl ester prepared within a silastic device for intravaginal administration appears to be advantageous. This study describes the technique carried out and the results observed in 50 patients. The analogue is prepared in 1.0% and 0.5% delivery systems. Twenty-four patients received the 1.0% dosage schedule and all twenty-four patients aborted. Twenty-six patients received 0.5% and twenty-three patients aborted. The coagulation millieu and other parameters were similar to that reported for other prostaglandins.

The efficacy of intramuscular 15 methyl prostaglandin E2 in second-trimester abortion. Coagulation and hormonal aspects.

Termination of pregnancy in the second trimester is sometimes associated with serious complications. This led to clinical investigation seeking methods superior to the traditional technique utilizing hypertonic saline. Intra-amniotic administration of naturally occurring prostaglandin F2-alpha has been developed and appears to be advantageous--especially in the area of coagulation stability. This study describes a technique for intramuscular administration of a prostaglandin analogue--15 methyl prostaglandin E2. This analogue is much more potent than the natural compound. Administration to 32 patients resulted in abortion in 28. The coagulation milieu remained completely intact and all other parameters were similar to previous published data for prostaglandin administration. There were no infections in this group of patients.

Midwifery, 1977.

On January 1, 1974, an autonomous midwifery service was formed at Roosevelt Hospital in New York City to provide an obstetric service to "private" patients. While the autonomy was complete, physician consultation and participation provided by the "full-time or senior resident" staff were always available. We are now aware that this plan as opposed to any other, provided the ingredient of consumer-desired empathy of the midwife coupled with instant obstetric expertise that assured every patient the availability of modern obstetric practice. Four hundred and fifty-four patients cared for by midwives were compared to a random sample of 500 patients cared for by attending obstetricians. A striking similarity in the two groups was evident. Certain items, such as operative deliveries, were higher in the private patient group. The midwifery group had a low incidence of complications, but the incidence of acute complications made it apparent that an operating room suite must be immediately available. It is eminently clear that a low-risk group can be identified but there is no possible way to identify a "no risk" population.