Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the literature.

Congenital disorders of development are more common than previously reported and the correct diagnosis is frequently missed leading to suboptimal treatment. Eight cases of uterus didelphys with obstructed hemivagina referred to the Gynecology service at Baylor College of Medicine over a 2-year period were reviewed. Initial presenting symptoms and signs were followed by an incorrect diagnosis by the referring physician 100% of the time. MRI, the most sensitive imaging modality for congenital anomalies (Kublik, RA: Female pelvis. Eur Radiol 1999; 9:1715), was utilized in only 50% of the cases. In this group of patients, hematocolpos and pyocolpos were discovered in equal numbers upon exploration. Ipsilateral renal anomalies were present 100% of the time, while coexisting contralateral anomalies were present 50% of the time. Resection of the vaginal septum was required for abatement of symptoms in all cases presented here. Laparoscopy provided additional information beyond radiologic tests regarding pelvic and urological anatomy. In two cases, resection of the ipsilateral uterine horn was required. These cases demonstrate the difficulty in diagnosis, heterogeneity in presentation, and need for expertise not only in this rare congenital anomaly but also all the other disorders of development of the female genital tract.

A prospective audit of external cephalic version at term: are ultrasound parameters predictive of outcome?

This prospective study was designed to audit our provision of external cephalic version (ECV) but also to assess the relative importance of various ultrasound markers as indicators of a successful outcome. Data were collected between November 1998 and November 1999. There were 102 breech presentations at term and 47 women had an external cephalic version. We had an overall success rate of 55% with no adverse outcomes. Parity, a non-extended breech presentation and posterior placenta were all independently associated with a higher success rate. As only 49% of women with an uncomplicated breech presentation at term agreed to have an ECV the audit has prompted us to assess how we might improve the uptake of our service. Given that fetal position and placental site seem to influence outcome, we would suggest that a basic ultrasound scan should form part of the procedure. The audit has confirmed the value of ECV in reducing the incidence of breech presentation at term. With the increasing caesarean section rate for this obstetric problem it is important that all units in the United Kingdom are able to provide this service.

Current issues in medical management of ectopic pregnancy.

This review focuses on current medical therapy for unruptured ectopic pregnancy. Recently emerging issues include early diagnosis, treatment costs, intratubal methotrexate injection, medical treatment of cervical and interstitial ectopic pregnancies, and future fertility potential after methotrexate therapy. In addition, new clinical practice guidelines identify optimal candidates for medical therapy.

Uptake of Pb by human skeleton and comparative metabolism of Pb and alkaline earth elements.

Measurements of the retention of 47Ca and of 203Pb were made following their administration by intravenous injection. Translocation to bone was measured by gamma counting the feet of subjects. Uptake by bone of 203Pb was comparatively slow and extrapolation to the whole skeleton indicated that 20% of the dose had been taken up within 20 days. By time, a similar fraction of the dose had been excreted in urine. These results are consistent with Kehoe's (Ke61) long-term balance studies on 2 human subjects given stable Pb orally. Uptake by bone of 47Ca was about 1.5-2 times the amount excreted in urine. Both the uptake by bone, and its excretion in urine, were more rapid than that of 203Pb due to the greater attachment of the latter to red blood cells. However, the plasma clearance rate for Pb, like that of Sr, was greater than that of Ca.

Uptake of lead by humans and effect of minerals and food.

In several series of experiments, volunteers have ingested 203Pb as chloride (a) in distilled water, with or without stable Pb carriers, while fasting, (b) with varying amounts of added mineral Ca and P, (c) with hot or alcoholic beverages between normal meals, (d) in the course of meals. Also, volunteers have eaten lamb's liver and kidney into which 203Pb had been incorporated by injection into the animal before slaughter, and spinach which had taken up 203Pb from its roots. Fasting subjects absorbed 40-50% of the 203Pb, taken in distilled water, irrespective of the addition of Pb carrier up to 100 micrograms per dose. When taken with tea or coffee, uptake averaged 14% and with beer 19%. Much lower uptakes, ranging from 3 to 7%, were found when 203Pb was taken in volunteers with a meal, or incorporated in offal or vegetables which were eaten as part of a meal, or when taken with large amounts of calcium or phosphate.

Effect of minerals and food on uptake of lead from the gastrointestinal tract in humans.

1 Eight adult male volunteers ingested 203Pb as chloride with varying amounts of CaCO3 and NaH2PO4. The uptake from the gastrointestinal tract declined progressively as the amount of minerals taken simultaneously was increased, in agreement with the findings of Blake (1980). 2 With four of the volunteers, further tests were done to compare the effect of the two minerals together and separately. With no minerals, uptake averaged 63.3% (range 58.6-66.7%). The two together (200 mgCa and 140 mgP) reduced it to 10.6% (range 8.6-12.8%), but neither mineral by itself was nearly so effective as the two together. 3 A lamb was injected with 203Pb and butchered after 6 days. Six volunteers ate the liver or kidneys as part of a meal. Uptake of 203Pb incorporated in the offal averaged 2.8% (range 1.6-4.7%). When 203Pb in solution was taken with inactive offal in a similar meal, uptake averaged 3.0% (range 1.7-3.6%). Thus incorporation of 203Pb in liver or kidney did not affect the uptake.

Uptake of lead by vegetable foodstuffs during cooking.

Uptake of Pb by foodstuffs during cooking has been identified as an additional potential source of human exposure to Pb. Vegetables and rice cooked in water containing Pb may adsorb up to 80% of the Pb in the water. The amount of Pb adsorbed was dependent upon the concentration of Pb in the water, type of vegetable, water hardness, salting of the water, duration of cooking and the available surface-area of the vegetables. Substantial deposition of Pb also occurred on the surfaces of the saucepan itself (Al greater than enamel greater than Teflon), with subsequent desorption under certain cooking conditions. During tea-making, the concentration of Pb in water was reduced by 30-40% due to adsorption of Pb by the tea-bags. The dietary significance of the adsorption of Pb by foodstuffs during cooking as an additional source of human Pb uptake is assessed.

Deposition in the lung and uptake to blood of motor exhaust labelled with 203Pb.

Inhalation of airborne lead from automobile exhaust is a significant source of intake. In these experiments a radioactive isotope of lead was used to label tetraethyl lead consumed in petrol engines. The resulting aerosols were inhaled by human volunteers to determine the percentage deposition in the lung, the pattern of removal from the lung and the resulting levels in the blood and excreta. Deposition in lung was shown to depend on particle size, varying from 40% for fresh, highly diluted aerosols to 14% for mature, aggregated aerosols, at a breathing rate of 15 breaths per minute. For aggregated aerosols the influence of rate of breathing, tidal volume and reserve volume was investigated. Uptake from the lung was rapid (T 1/2=6.6 h) and virtually complete with little, if any, ciliary clearance. Fifty per cent of the labelled lead remained in the blood, the concentration peaking after 2 days and subsequently declining exponentially (T 1/2 = 16 d). Total excretion was of the order of 1% of the intake per day up to 15 days.