Secreción por ambas axilas sin presencia de pezón supernumerario / Lactation from bilateral axillary breast tissue in the absence of a supernumerary nipple

Paciente que presenta secreción por ambas axilas en su octavo día de puerperio. En la exploración no presenta pezón supernumerario y la secreción se produce por los poros de la piel. El estudio ecográfico demuestra tejido mamario ectópico.Las malformaciones congénitas de la mama aparecen hasta en un 10% de la población. La existencia de tejido mamario en algún punto de las líneas mamarias se clasifica, según Kajava, en 8 clases, que se diferencian por la presencia o no de aréola, pezón y tejido glandular. Nuestro caso es una clase IV de Kajava.Ante una malformación mamaria, la actitud conservadora parece ser la más correcta, aunque por razones estéticas es común la realización de cirugía. Será necesario tener en cuenta la mama supernumeraria para el cribado del cáncer de mama

We report the case of a patient who developed bilateral axillary secretion on the eighth day of lactation. On examination, there were no supernumerary nipples and secretion was through the skin pores. Ultrasound study revealed ectopic breast tissue.Congenital breast malformations occur in up to 10% of the general population. The presence of supernumerary breast tissue in any point of the milk lines has been classified by Kajava into eight types, distinguished by the presence or absence of areola, nipple, and glandular tissue. Our patient had a class IV malformation in Kajava’s classification. A conservative attitude to breast malformations may be the optimal approach, although surgery is frequently performed for cosmetic reasons. It is important to be alert to the possibility of breast carcinoma in ectopic tissue

Depression of FSH and LH secretion following pulsatile GnRH administration in ovariectomized women.

To investigate the mechanism by which pulsatile administration of gonadotrophin-releasing hormone (GnRH) modifies secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), we studied three groups of five women who had been ovariectomized for non-malignant gynaecological conditions at least 6 months previously, none of whom had received substitutional hormone therapy. Before and after 15 day treatment with subcutaneous pulsatile GnRH (one 20 microg dose every 90 min in group A, one 10 microg dose every 90 min in group B and one 20 microg dose every 120 min in group C), pulsatile secretion of LH and FSH was characterized by determining these hormones in 4 ml blood samples taken every 10 min for 8 h (9.00 a.m. to 5.00 p.m.). For both LH and FSH, mean serum concentration and pulse amplitude were lower after GnRH treatment than before (and in the case of LH the decrease depended upon both the size and frequency of exogenous GnRH pulses) but in no group was there a significant change in LH or FSH pulse frequency. We conclude that exogenous pulsatile GnRH probably acts by partially desensitizing the pituitary rather than by depressing endogenous GnRH secretion. Such partial desensitization would explain reports that exogenous pulsatile GnRH improves ovulation by women with polycystic ovary syndrome.

[Use of a combination of non stress fetal heart rate monitoring and the oxytocin challenge test in high-risk pregnancies. The effects on perinatal mortality (author's transl)]. / Emploi combiné du monitorage foetal non stressant (MFNS) et de l'épreuve à l'ocytocine (oxytocin challenge test = OCT) dans les grossesses à haut risque: effets sur la mortalité périnatale.

A protocol for antepartum supervision which included "non stress fetal monitoring" (NSFM) and the "oxytocin Challenge Test" (OCT) was followed in a series of 640 high-risk pregnancies. The perinatal mortality in this group was compared with that obtained in a group of 3,049 non-selected deliveries which occurred during the same period of time and which were not monitored in the same way. The perinatal mortality which could be attributed to placental insufficiency in the first group (the supervised group) was at 4.68 per 1000, about half that of the non-supervised group (8.72 per 1000) in spite of the low number of high risk cases in the second group. When NSFM was normal in the week before delivery there was no single perinatal death due to placental insufficiency. When the NSFM was normal and the OCT was pathological the OCT Test was probably wrong. When the NSFM test was non-reactive placental insufficiency could be predicted in only 28 per cent of the cases although a combination of NSFM with a positive OCT Test predicted correctly 91.3 per cent of the cases of placental insufficiency. We consider that there is fetal distress due to placental insufficiency when having found signs indicative of fetal distress in delivery (a pH of less than 7.25, recent passage of meconium, the Apgar score less than 7 in the first minute, and pathological fetal heart rhythm (RFC) we can find no other cause to explain the signs such as a short cord, prematurity, obstetrical trauma, prolonged pregnancy and malformations, etc.

[Sequential test with clomiphene and LH-RH in cases of anovulatory sterility (author's transl)]. / Le test séquentiel clomifène-LH-RH en cas de stérilité due à un cycle anovulatoire.

In sterile menstruating women with anovulatory cycle, the response of plasmatic gonadotropins and urinary total Estrogens and Pregnandiol to the administration of Clomifene and LH-RH in a sequential test is studied. Five different types of response, similar to those detected in previous studies using the LH-RH test, are identified; in them, uniformity in the response of gonadotropins exists to both LH-RH and Clomifene. The results obtained seem to confirm the existence of diverse etiopathogenic mechanisms in the alterations of the Hypothalamus-Pituitary-Ovarian axis resulting in anovulatory cycle.

[The antepartum oxytocin fetal assessment challenge test 1,827 case histories. Significance of "prepathological testing". "Results" (author's transl)]. / L'épreuve de tolérance foetale à l'ocytocine antépartum. A propos de 1.827 cas. Signification des "epreuves prépathologiques". "Resultats".

We carried out the Oxytocin Challenge Test (or OCT as American authors call it) by injecting 5 m.U. per minute into pregnant women who are suspect of having high fetal risk from the 34th week of pregnancy onwards. The material that we have examined is from 1,366 cases with 1,827 tests. The perinatal mortality over all was 13.17 per thousand of the cases. We have described three types of response: normal (87.44%), pre-pathological (7.77%) and pathological (6.78%). We have concluded that the test has a good prognostic value and point out the significance of the pre-pathological results, which we think have up till now not been accorded sufficient attention.

[Biological parameters of virilism in women]. / Paramètres biologiques du virilisme féminin.

Comparative results of the suppression-stimulation test by dexamethasone and chorionic gonadotropin, chromatographic separation of 17-ketosteroids, and plasma testosterone levels in the ovarian and adrenal veins, in cases of virilism in women. Thirteen patients with hirsutism and virilization were investigated as follows: 1. measurement of plasma testosterone (T) levels by radioimmunoassay (RIA) during suppression-stimulation tests by the administration of Dexamethasone (DXM) and chorionic Gonadotropin (HCG). 2. chromatographic determination of urinary 17-ketosteroids, pregnanediol (P2), and pregnanetriol (P3). An attempt was made to classify virilism as "ovarian" or "adrenal" based on the results of 1. and 2. 3. bilateral ovarian and adrenal venous catheterization through the femoral vein to measure T (RIA) levels. 4. laparotomy with bilateral wedge resections of the ovaries for therapeutic and biopsy purposes. Surgical catheterization of the ovarian veins was carried out during the operation. The results of these tests show that: a) the dynamic DXM-HCG test can be used to separate those cases in which the ovary is not involved in T formation from those in which, apparently, it is involved. b) chromatographic determination of urinary steroids has no aetiological value, as the variations in the different fractions are not significant. c) in all patients, the principal source of T is the adrenals and not the ovaries, even when there is an increase in T in the ovarian efferent blood vessels.

Gestational meconium: a sign of poor neonatal prognosis.

Seventy five pregnancies where the presence of antepartum meconium was detected by transabdominal amniocentesis, were compared with 224 cases showing clear amniotic fluid (A.F.). The statistical differences were analized in terms of data of anamnesis, diseases complicating pregnancy, gestational age, fetal maturity diagnosis from the A.F. study, oxytocin test, labor characteristics, perinatal mortality and neurologic morbidity during the first nine months of life. The results suggest that the presence of antepartum meconium implies an increase in fetal risk, demanding an adequate analysis of the obstetric solutions, which is discussed.