A rare obstetric contraindication to the use of vaginal prostaglandins for fetal demise

A rare obstetric contraindication to the use of vaginal prostaglandins for fetal demise is presented in the form of a case report. After two failed pitocin inductions for a third-trimester fetal demise, a patient was referred to the University of Washington for definitive management. She was delivered of an advanced intraligamentous pregnancy at laparotomy. Preoperative diagnosis can avert a futile attempt at evacuation of the dead fetus, but preoperative diagnosis of intraligamentous pregnancy is rare. When the cervix is found in the extreme anterior position high in the vagina behind the symphysis and the fetal head is below it, the diagnosis of extrauterine pregnancy should always be considered.

[Description of a new modified clamp for the parametrium in abdominal hysterectomies (author's transl)]

A new modified clamp for the parametrium is presented which facilitates abdominal hysterectomy in large myomatous uteri. The curbed clamp has a blunt angle of 160 degrees to its handle and permits clamping of the parametrium parallel to the longitudinal axis of the cervix. The clamp appears to be an enrichment of the available instruments for abdominal hysterectomies.

Complications following parametrial radiogold treatment for cervical carcinoma

Between January 1950 and March 1965, 382 patients with carcinoma of the uterine cervix were treated with parametrial radiogold injections. One hundred and ninety-two patients are known to have survived 5 or more years after the treatment without evidence of recurrence. Major complications with significant morbidity requiring hospitalization or additional surgery was observed in 9.4% of the patients. Parametrial radiogold injection is associated with a high incidence of major lower urinary tract complications, including an increased incidence of ureteral obstruction as a result of radiation fibrosis, Heterogenous distribution of radioactive material with localized areas of heavy irradiation is probably responsible for the development of late major complications.

Lipoprotein lipase and uptake of triacylglycerol, cholesterol and phosphatidylcholine from chylomicrons by mammary and adipose tissue of lactating rats in vivo

The relationship between lipoprotein lipase activity and uptake of triacylglycerol, cholesterol and phosphatidylcholine from chylomicrons was studied in mammary gland and adipose tissue of rats lactating 6--7 days. 60% of triacylglycerol [14C]oleic acid, 13% of [3H]cholesterol and 8% of [32P]phosphatidylcholine in chylomicrons injected intravenously were taken up within 11 min by mammary gland whereas negligible amounts were taken up by adipose tissue. Non-suckling for 44 h decreased markedly uptake of all lipids by mammary gland and retarded clearance of chylomicrons from blood, while it increased significantly uptake of triacylglycerol fatty acids and cholesterol by adipose tissue. Non-suckling also decreased lipoprotein lipase activity in mammary gland from 7.7 to 0.4 units/g, while it increased activity in adipose tissue from 0.1 to 2.7 units/g. These findings indicate that lipoprotein lipase is involved in uptake of chylomicron triacyglycerol and cholesterol by mammary gland and adipose tissue, and also in uptake of chylomicron phosphatidylcholine by mammary gland. They also show that reciprocal changes in lipoprotein lipase activity in mammary gland and adipose tissue, as occur during lactation, result in diversion of chylomicron lipids from one tissue to the other.

[Ultrasound diagnoses and cardiotocography in case of full-time carried intraligamentous gravidity (author's transl)]

Description of the course of disease concerning an intraligamentous pregnancy carried to full term, but diagnosed only during operation. Subsequent evaluation of the ultrasonic and cardiotocologic graphs. Constantly rectilinear pressure curves without uterine activities are interpreted as characteristic tocographic criteria of an advanced ectopic gravidity.

Translocation of the Dalkon Shield into the broad ligament

Perforation of the uterus is a serious complication in users of intrauterine devices for contraception. The incidence varies with the type of device. The perforation can occur in different parts of the uterine wall. Perforation into the broad ligament is rare; only 4 cases have been described. Two additional cases, both occurring with the Dalkon Shield, are reported here.

Dystocia and broad ligament hematoma secondary to hip pinning

A case of dystocia and broad ligament hematoma after hip pinning is presented. Abdominal section was performed after a secondary arrest of labor and failure of descent.