Changes in menstrual blood loss and libido after different methods of tubal ligation.

A study was carried out to investigate the menstrual blood loss and changes in sexual life following two methods of tubal sterilization, the Pomeroy procedure and fimbriectomy, as compared with a control group having undergone Cesarean section alone. Results support the approach that hysterectomy be performed in older women, over the age of 40, and fimbriectomy in younger patients, in whom further pregnancy or reanastomosis of the Fallopian tube is absolutely contraindicated.

The use of biological dressings in radical vulvectomy.

The use of biological dressing techniques accelerates recovery from radical vulvectomy combined with lymphadenectomy. Our earliest interest in the field arose as a result of the morbidity rate which ensued subsequent to surgical therapy of cancer of the vulva. The technique involved in 8 such procedures is described, and its applicability illustrated with photographic plates and review of the literature.

Ovarian teratoma with peritoneal gliomatosis and elevated serum alpha-fetoprotein.

An adolescent girl, had a grade 1 immature teratoma combined with a rare manifestation of glial peritoneal implants of grade 0. A unilateral salpingo-oophorectomy was performed. Alpha-fetoprotein levels, which were elevated before the operation, returned to normal. The patient has been symptom-free for more than three years after the surgical treatment. Repeated normal assays for alpha-fetoproteins can serve as a guide to a projected favorable course. The World Health Organization grading of the teratoma is listed and pertinent medical literature is briefly discussed.

Propranolol and hydrallazine in the management of essential hypertension in pregnancy.

A combination of propranolol and hydrallazine was administered to 13 patients with longstanding hypertension during 15 pregnancies. Hydrallazine was continued through labour and delivery in all patients, while in eight patients propranolol was discontinued 2 to 15 days before delivery. Blood pressure control was uniformly good and superimposed pre-eclampsia did not occur during combined therapy. There were 14 livebirths and one unexplained stillbirth. Except for two cases of milk hypoglycemia, there were no neonatal complications.

Emergency obstetric anaesthesia and the use of beta2-sympathomimetic drugs.

A case of severe foetal distress is recorded and the rationale and use of a beta-sympathomimetic drug are described.

Fetal response to periodic sleep apnea: a new syndrome in obstetrics.

Periodic sleep apnea, a chronic sleep deprivation state, in which marked changes in the arterial PO2 and PCO2 tensions have been recorded, is a relatively new syndrome not previously reported in pregnancy. It is characterized by episodes of apnea, prevalently obstructive, during sleep. The majority of patients with this syndrome have snored heavily for years, suggesting a causal relationship between snoring and periodic sleep apnea. The effects of prolonged snoring on alveolar ventilation and systemic pressure(s) suggest that this snoring has physiopathological implications on maternal cardio-respiratory reserve and indirectly upon the fetus, especially as there are recordable changes in fetal heart rate and also a change in the acid-base status of the fetus. The possibility that this syndrome may have an adverse effect upon the fetus is stressed.

Necrotizing fasciitis.

Two cases of necrotizing fasciitis, a disease poorly documented in the gynecologic literature because of its extreme rarity, are described. These are the only cases of this entity seen in our department during the last 24 years. Both patients underwent major surgical procedures for uterine stromal sarcoma and mixed mesodermal tumor. In both, the pathognomonic signs, undermining of the skin, and extensive necrosis of the subcutaneous tissue and the underlying fascia, were present. Later gangrene occurred, and both patients died. The literature is briefly reviewed, which emphasizes the importance of immediate surgery when the disease is recognized. The possibility is suggested that the development of such local processes in cases of mixed mesodermal tumor may be an immunologic reaction and the cultured organisms contaminants.

Ovarian abscess associated with incomplete abortion and intrauterine contraceptive device.

A 28-yera-old woman with an intrauterine device (IUD) was admitted to hospital with signs of incomplete abortion. The IUD was removed and curettage revealed necrotic infected decidua with no trophoblastic cells or chorionic villi. The patient subsequently developed multiple abscesses in the right ovary. The mechanism of development of ovarian abscesses in patients with IUD or with infected incomplete abortion is discussed.