Burkitt's lymphoma of the ovaries.

A case of Burkitt's lymphoma involving both ovaries of a 15-year-old Guatemalan girl is presented along with a brief review of the pertinent literature.

Disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) is not uncommon in the obstetric patient, but DIC of sufficient severity to be of clinical importance is unusual. Treatment of DIC is directed primarily at its cause. Replacement of depleted blood components with packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets is sometimes required for treating hemorrhage. Heparin should be used only rarely, and only to help control life-threatening hemorrhage because DIC is refractory to vigorous and adequate blood-component therapy. With careful planning of treatment, adherence to a few general principles, and the combined approach of an obstetrician and a coagulationest, fatalities and major morbidity should be rare.

Ruptured spleen as a differential diagnosis in ruptured tubal pregnancy.

Two cases of traumatic biphasic or secondary splenic rupture are presented to demonstrate the clinical picture of an entity the obstetrician-gynecologist will be encountering more commonly in the future. The signs and symptoms of this condition figured prominently in the differential diagnosis of ruptured tubal pregnancy.

The role of the obstetrician-gynecologist in the management of breast lesions.

This paper is based on the author's frequent experience in the diagnosis of breast masses in his everyday practice as an obstetriciangynecologist. It appears that gynecologists, by the very nature of their practices, are in an excellent position to head the case-finding expedition for breast lesions. Furthermore, the obstetrician-gynecologist can use acquired surgical skills to great advantage in the management of benign lesions and assist surgical associates in the management of the malignant lesions.

Cesarean section: a seven-year study.

This paper reports a seven-year study of cesarean section practices at the Queen of Angels Hospital, Los Angeles, California. Indications for this procedure are listed in detail and an attempt is made to explain its increasing frequency. Practicing physicians were interviewed and testimony seemed to indicate, as was suspected, that fear of malpractice suits was one of the reasons for cesarean section. The conventional wisdom of "once a section always a section" is questioned with regard to an increasing number of trials of labor and vaginal deliveries, when they are considered feasible and safe. The federal government is manifesting serious interest in this increased number of operative deliveries in the light of cost effectiveness.

Carcinoma of the ovary.

The data for this paper are based on 50 patients discharged from the Queen of Angels Hospital with a diagnosis of carcinoma of the ovary from 1972 to 1978.Currently, ovarian cancer is the leading cause of death of all pelvic malignancies. Peak incidence of ovarian cancer is found in women between 40 to 65 years of age. Symptomatology includes often vague abdominal discomfort, dyspepsia, and other digestive disorders which may be present for several months prior to diagnosis.The workup for suspected ovarian cancer should include a careful history, physical examination, pelvic, and rectal examinations, Pap smear, CBC, urinalysis, SMA 12 (blood chemistries), chest x-ray, and intravenous pyelography as indicated. Sonography, lymphangiography are optional.Traditionally, operative treatment has been the keystone of management for ovarian carcinoma. In view of the unsatisfactory results with operation and radiotherapy in disseminated disease, chemotherapy has been used widely. Hope for the future lies in further development of immunodiagnosis and immunotherapy.

Ectopic pregnancy: current clinical trends, a fifteen year study.

PIP: This paper reviews the clinical recognition, diagnosis, and management of ectopic pregnancy at the Queen of Angels Hospital for the past 15 years. The incidence of ectopic pregnancy to deliveries is 1:195. Pain is the cardinal symptom of ectopic pregnancy, and amenorrhea of some degree was present in all cases. Pelvic inflammatory disease is a factor in the development of tubal pregnancy in some women. A careful history and thorough physical examination are important in making a careful diagnosis. The only laboratory procedures which are of any value are the blood type and the Rh determination. While examination of endometrial tissue obtained by biopsy or curettage has proved useful in ectopic pregnancy diagnosis, it is not totally decisive. Culdocentesis has proved to be the diagnostic procedure of the greatest value in recognizing intraperitoneal hemorrhage and it increases the correct preoperative diagnosis from 65-70% to 95%. Laparoscopy is useful when the physician is in doubt about the nature of the problem and it has produced an increase in the number of ectopic pregnancies diagnosed. Ultrasound is another useful tool in confirming a diagnosis of ectopic pregnancy; its accuracy ranges from 70-92%. A newly developed pregnancy test is more sensitive than conventional pregnancy tests and would be positive for pregnancy. Women who have had a previous ectopic pregnancy have a higher subsequent incidence of persistent infertility, recurrent ectopic pregnancy, and pregnancy wastage; the risk of another ectopic pregnancy increases 30-50 fold. While extopic pregnancy does recur, it is true that about 1/3 of those women do have successful pregnancies. Where previous induced abortion has occurred, there is a 10-fold increased risk of ectopic pregnancy. Women who become pregnant accidentally with an IUD in place have a greater likelihood of experiencing an extrauterine pregnancy. Abdominal pregnancy is often encountered as an aborting ectopic pregnancy during the 1st trimester. In cases such as this, there can be local excision and hemostasis. Idiopathic thrombocytopenic purpura was another encountered complication. Salpingectomy is inappropriate and even dangerous when used with an ectopic pregnancy. Early diagnosis and prompt surgery can help increase the survival rate. However, conservative surgery which preserves the tube is feasible and practical using salpingotomy and partial salpingectomy. Maternal death resulting from ectopic pregnancy is usually the result of sudden massive hemorrhage. The initiation of therapy prior to rupture is helpful. Ectopic pregnancy rate has remained fairly consistent among the white population but has decreased significantly in the nonwhite population. This is likely tied to an improvement in socioeconomic status, better patient education, and a greater awareness of medical needs. To decrease the maternal mortality rate from ectopic pregnancy, obstetricians and gynecologists must be more aggressive in research and treatment of ectopic pregnancy.^ieng

Renal shutdown as a complication of severe preeclampsia with premature separation of the placenta.

The author, with long experience in the management of toxemia of pregnancy and its multiple complications, is reporting his first case of complete renal shutdown after severe preeclampsia complicated by premature separation of the placenta, and complications of disseminated intravascular coagulopathy.Multiple hemodialyses provided a breakthrough to what appears to be a complete reversal and return of normal renal function.

Five year study of postpartum hemorrhage: Queens of Angels Hospital, 1973--1977.

Postpartum hemorrhage accounts for about one quarter of the deaths in the obstetric hemorrhage group. Blood loss is the most important underlying cause of morbidity. To save blood, the obstetrician must partice "preventive medicine" by being cognizant of any situation during pregnancy, labor and delivery which may result in increased blood loss.The methods and principles by which these situations can be prevented or treated are discussed.

Surgical complications of gynecologic surgery.

Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease.Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control.It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist.

Massive fibroid.

This ten-year study of the massive fibroid at the Queen of Angels Hospital will reveal an average of 66 cases per year which could be classified as large and massive. Only about ten cases per year qualify as massive (four gestational months or larger). There were none considered giant size (25 lbs or more).The literature is replete with these, one of which (weighing 100.2 lbs) will be reported in detail. The mortality rate continues to be considerable in these (14.8 to 16.7 percent). In the smaller tumors, mortality is rare and morbidity is minimal.Bleeding, pain, and pressure symptoms, due to impingement on neighboring organs, are the principal symptoms. Sarcomatous change, fortunately, still remains quite rare.Treatment usually involves a pre-operative dilatation and curettage when bleeding is a problem, followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy where indicated. Appendectomy is usually incidental. Anesthesia is usually spinal, if not otherwise contraindicated.Ultrasound is a new and refined diagnostic tool.