Aberrant breast tissue of the vulva. A case report and review of the literature.

Aberrant breast tissue may occur anywhere along the embryonic milk line. Only 17 instances of breast tissue of the vulva have been recorded in the English literature between 1900 and 1976. Review of these cases, as well as features of the patient herein reported, serve as a basis for presenting a clinical profile of this interesting entity, its potential complications, and a rationale for appropriate management.

Epidural analgesia and its effects on the "normal" progress of labor.

The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.

Ovenstone Factor in the management of Rh sensitization.

Several methods have been developed for analyzing amniotic fluid to aid in the management of rhesus isoimmunization. Because all methods attempt to predict the severity of fetal hemolysis based on the original findings of Bevis and on the amount of unconjugated bilirubin in amniotic fluid as measured by its optical density at 450 millimicron, they share two possible sources of error: calculation of exact gestational age and accurately reading bloody or contaminated amniotic fluid. The Ovenstone Factor measures the derivative of the bilirubin curve against wavelength and thereby avoids some of the contaminating pigments at 450 millimicron. This paper compares the predictive accuracy of two methods, Liley versus Ovenstone Factor, in 78 samples of fluid from 46 patients. Predictions were correct in 80% of infants using Ovenstone Factor and 67% using the Liley curve, and incorrect in only 7% and 13%, respectively. The Ovenstone Factor, with its simplicity and high predictive accuracy, is an excellent additional tool in the management of Rh-sensitized pregnancies.

A comparison of the clinical performance of students in three-and four-year curricula.

The purpose of this paper is to report the clinical performance of medical students prepared in three-and four-year curricula. The students were evaluated in five categories: fund of knowledge, medical skills, problem-solving, professional standards, and reliability. The examination of the National Board of Medical Examiners were administered in three of the clinical clerkships. The results indicate that the students performed equally well in most areas, and little difference in clinical performance could be demonstrated between the groups.

Accurate amniotic fluid bilirubin analysis from the "bloody tap". A preliminary report.

The quantitation of bilirubin in amniotic fluid is of paramount importance in prognosticating the severity of Rh isoimmunization. Amniotic fluid contaminated by maternal blood can result in erroneous results when direct spectrophotemetric analysis is performed on such fluid. The technique and results of a one-step chloroform extraction performed on "bloody" amniotic fluid is presented. Results confirm that chloroform extraction yields more accurate clinical information in regard to Rh isoimmunized patients in whom a "bloody tap" is obtained.