Strangulation of the umbilical cord due to combined amniotic band and true knot.

A case of fetal death due to an amniotic band and an umbilical cord true knot is presented. To the best of our knowledge the simultaneous occurrence of true knot of cord and amniotic band has never been previously reported and may shed light on the possible time of true knot formation in this case.

Unilateral congenital short femur: a case report.

A case of congenital short femur in an otherwise healthy infant is described. Antenatal sonographic diagnosis was made at 26 weeks of gestation. The left femur was shorter than the right (ratio 0.82-0.85). In this case, the occurrence of congenital short femur was sporadic. The diagnosis was confirmed after delivery. This case illustrates the importance of ultrasound as an early detector of certain congenital anomalies and as a useful tool in their follow-up.

Ovarian tumors in pregnancy.

Thirty-eight women were operated for an ovarian tumor diagnosed during pregnancy, with an incidence of 1/2328 deliveries. The diameter of all tumors was above 5 cm. Of the 31 women operated before delivery, seven were untreated and 24 received supportive progestational therapy. The rate of abortions was 85.7% in the untreated group and 10% in the hydroxy-progesterone-caproate group (HPC) (P less than 0.02). When the women received a total dose of HPC of more than 300 mg, 9 of 10 pregnancies reached term with a live child. Two ovarian malignancies were found, 5.3% of all cases. In 42.9% of the women there were fertility problems later in life. Ovarian tumors during pregnancy should be removed as soon as possible, irrespective of the age of the pregnancy. If fully progesterone therapy is given, the danger of abortions is reduced to a minimum. Prophylactic antibiotic treatment should also be administered.

Female pseudohermaphroditism with adrenal cortical tumor in adulthood.

Data are presented concerning a case of female pseudohermaphroditism of unknown etiology. The child was born with labioscrotal fusion and clitoromegaly. From the age of 5 to the age of 25 there was no clinical evidence of a hormonal abnormality. At the age of 25 the patient presented with masculinization and Cushing's syndrome, and a left adrenal tumor was removed. The patient was restudied at the age of 29, when 21-hydroxylase deficiency was excluded. Other types of congenital adrenal hyperplasia are considered unlikely. The possible relationship between the ambiguous genitalia present at birth and the virilizing tumor diagnosed at the age of 25 is analyzed.

Endometrial foam cells. Non-estrogenic and estrogenic.

Four patients with endometrial foam cells are described. In one the endometrium was obtained after parturition. It showed decidua and endometritis, whereas in the second patient, who had received birth control medication in the past, the endometrium was proliferative. In both cases there was a considerable amount of endometrial hemorrhage. The foam cells in these two patients had little granularity, and their cytoplasm contained hemosiderin. The other two patients received exogenous estrogen and presented with endometrial hyperplasia and adenocarcinoma. In these latter cases the foam cells were more granular, and contained no hemosiderin. Our findings confirm the presence of two types of histologically similar endometrial foam cell: a histiocytic, "non-estrogenic" reactive type capable of phagocytosis, and a stromal, "estrogenic" non-phagocytic type which is associated with hyperplasia or carcinoma and which may also be related to estrogen administration. Staining for hemosiderin may be particularly helpful in differentiating between the two types of foam cell. Such a differentiation is of practical importance because of the biologic significance attached to the "estrogenic" foam-cells which are usually indicative of endometrial hyperplasia or carcinoma.

Hydrops fetalis caused by maternal indomethacin treatment.

Hydrops fetalis was diagnosed in one of two twins, while the other suffered from cardiac failure. Indomethacin administered to the mother to arrest premature labor, seemed to be the predisposing factor resulting in the hydrops fetalis. The possible relationship between intrauterine closure of the ductus arteriosus and the pathogenesis of hydrops fetalis is discussed.

Constriction of the umbilical cord by an amniotic band after midtrimester amniocentesis.

Constriction of the umbilical cord by an amniotic band after previous midtrimester amniocentesis is an extremely rare entity. A case report of fetal asphyxia caused by partial occlusion of the umbilical cord by an amniotic band is presented. Clinical and experimental evidence strongly suggests that the pathogenesis of this defect is related to early rupture of the membranes during gestation with subsequent encirclement and ligation of fetal umbilical cord, or extremities. In this case, formation of the amniotic band caused by midtrimester amniocentesis is strongly suggested. Obstetricians should be aware of this hazardous complication during pregnancy and labor in women who had had a midtrimester amniocentesis.

Tuberculoid cornstarch granulomas with caseous necrosis. A diagnostic challenge.

We studied a patient in whom peritoneal granulomas developed with caseous-type necrosis after exposure to cornstarch from surgical gloves. This necrotizing type of lesion, which is the least common among cornstarch granulomas, can simulate tuberculous infection and lead to initiation of antituberculous therapy. A review of the literature suggests that there are two basic types of cornstarch granulomas: the phagocytic, foreign body type, and the tuberculoid granuloma with and without central necrosis. The morphologic features and possible mechanism of formation of these types of granulomas are being discussed. Although the cornstarch particles can be identified with a variety of stains, the most reliable method is that of examination with polarized light, which is recommended in all cases of granulomas, especially abdominal ones.

Early complications and sequence of pregnancy interruption with hypertonic saline.

Midtrimester abortions and a number of cases with missed labor were induced by intrauterine instillation of 30% saline solution in 103 women. The instillation-abortion time was relatively short (mean 25.4 h) while oxytocin was not needed for the augmentation of contractions either in elective abortions or missed labor. Eighty-seven women had a curettage after the abortion; this was directly related to fetal weight. The first puncture was unsuccessful in 11 women (10.7%) and a second puncture was made a week later. Ten women had early complications, mainly fever for a few days; there were no instances of uterine perforations or disseminated intravascular coagulopathy (DIC). Postabortal curettage decreased the incidence of early complications. All study patients had a follow-up examination after 2 to 22 yr from the abortion. In 10 women some sequelae were found, but only in three women was the problem possibly related to the saline abortion (hydrosalpinx, incompetent cervix, and intrauterine adhesions). Of 71 women who subsequently wished to become pregnant, 69 succeeded: seven had more than one pregnancy, in three there were recurrent abortions. In 94 patients menstruation was normal, in eight bleeding became heavier, and there was one case of oligomenorrhea. In the authors' experience and contrary to other publications, midtrimester abortion with concentrated saline has been safe and rapid, and late sequelae have been rare and less important than after early induced abortions.

PIP: This study is a longitudinal follow-up of 103 women (mean age, 29.7 years) who had hypertonic saline (30%) induction of midtrimester abortion or of labor with fetal death in utero. Mean instillation-abortion time was relatively short, 25.4 hours. Oxytocin was not needed for augmentation of contractions either in elective abortions or missed labor. 90.3% of the women (93) did not exhibit any early complications. Fever and signs of low-grade infection were observed in 8 patients, and hemorrhage in 2. In 71.9% of patients, menses returned within a month after the operation. All patients had a follow-up exam after 2 to 22 years from date of abortion. In 3 women, sequelae possibly related to the saline abortion (hydrosalpinx, incompetent cervix, and intrauterine adhesions) were observed. 69 out of 71 women who desired to become pregnant succeeded. In 94 patients, menses were found to be normal. In 8, bleeding became heavier, and in 1, oligonomenorrhea occurred. The authors concluded that 30% saline induction of midtrimester abortion is simple and effective, and eliminates need for laminaria, oxytocin, additional prostaglandins, and intrauterine or routine oral antibiotics. Reproductive and gynecological complications are minimal.