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Epidural Anesthesia for cesarean section
Volume 66 iXumber 1
SELECTED
5 years or more succumbed; one patient publication. In the absence of adequate is problematic, but the author cautiously ative eases tends to be somewhat higher Definitive evidence in favor of this idea experience.
Netto,
Pedro Ayres:
ABSTRACTS
219
of the short-term group had died at the time of control material, the evaluation of these results concludes that the percentage of cure in the operthan in those patients receiving irradiation alone. would consist, of course, of a much more extensive DOUGLAS
Cancer of the Endometrium,
An.
brasil.
de ginec.
M.
HAYNES
31: 209, 1951.
The author in this paper analyses the incidence of cancer of the endometrium in his clinic at 850 Paula, and finds that among a series of 1,263 cases of cancer of the uterus, only 8 cases of cancer of the body of the uterus were found. This incidence of I:158 is below the world statistics. Etiology of corpus cancer is discussed, particularly its relation to endometrial hyperplasia and endometriosis. In the Clinic of the Institute of Viera de Carvalho among I9 cases of cancer of the endometrium only one case of endometrial hyperplasia was found. A general survey of uterine tumors observed at the clinic is reported. Among a total of 15,800 pathological examinations 1,838 uterine tumors were found: 1,263 were cancer of the cervix, 305 were fibroids, and there were 256 cases of glandular hyperplasia of the endometrium. The highest incidence of cancer of the endometrium was in the age group between 50 and 60 years, after the menopause. The author favors surgical treatment preceded by intracavitary radium, and statistics showing results of this treatment are quoted. REARDO
L.
GORBEA
Cesarean Section Pommerenke, pita&
W. T.: New
York
Cesarean Sections: State
J, Med.
52: 2785,
A Twenty-five-year
Survey in a Teaching
Ho&
1952.
The author presents the results in all of the cesarean sections performed in the twenty-five year period of its operation in the Department of Obstetrics and Gynecology of the University of Rochester. A total of 682 operations were performed, an incidence of 2.2 per cent of all deliveries. The indications for operation were numerous and varied as is the case in modern obstetrics with the general broadening of indications for this operation. The most frequent Indication was that of a previous cesarean, 13.8 per cent, closely followed by contracted pelvis, 10.4 per cent, and antepartum hemorrhage due to premature separation of the placenta, 6.6 per cent, or placenta previa, 5.0 per cent. There were 7 maternal deaths, a maternal mortality of 1 per cent, and, of these, 3 deaths were very definitely not due to the operation, but rather to underlying factors present. There were 26 (3.9 per cent) stillbirths, and 33 (5.1 per cent) neonatal deaths. Of the stillbirths, the majority were due to premature separation of the placenta which was More than half of the neonatal deaths were due to prethe indication for the operation. maturity or atelectasis. The paper is of particular interest in presenting the entire cesarean section experienee of a clinic first opened in 1926 down to the present time. KARL
M.
%‘ILSON
Ansbro, F. Paul, Gordon, Charles A., Eodell, Benson, and Latteri, Francis S.: Epidural esthesia for Cesarean Section, New York State J. Med. 52: 1901, 1952. The author first reviews the cesarean section with a comparison description of epidural anesthesia,
An-
various forms of anesthesia (general, local, spinal) for A detailed of hazards involving both mother and baby. with reasons for its use, namely, less spinal headache,
less risk of grave neurologic complications, and less fall in I~lood pressur~!s, is giver,, will1 special reference to the epidural space and an outline of the technique of epidural block. Schematic drawings illustrate by cross section the spinal column with special emphasis placed on the three ligaments to be traversed prior to reaching the epidural space. -1 phot’ograph of the necessary equipment to carry out this procedure is also shown. The results of 125 cesarean sections performed by various operators under epidural block anesthesia are discussed. No maternal mortality and no headaches were encountered. Any drop in blood pressure which occurred was usually gradual and therefore more read+ controlled. All anesthesia for the epidural block was given by trained anesthesiologists, thereby placing this form of anesthesia in a more specialized class, not for general use in all cesarcan sectious. 1:. 0. HUGHES
Ectopic Pisani,
Bernard
J.: and
Hemorrhage
Management Shock, Surg.,
Pregnancy
of &topic Pregnancy With Gynec. & Obst. 95: 149, 1952.
Massive
Intraperitoneal
In a very timely and succinct paper the author points out the need for immediate operation to control hemorrhage associated with ectopic pregnancy, even in the face of severe shock. This is contrary to the old teaching, that patients in shock should not be operated upon, but stems from one of the real surgical lessons of the last war. There were 322 patients at Bellevue operated upon for ruptured ectopic pregnancy during the last 13 years with but one death, and that due to infection. Of these, there were 35 who prr sented signs of massive intraperitoneal hemorrhage and shock. These m-ere treated as follows: (I) immediate surgery (average interval between admission and operation :;.Z hours) ; (2) concurrent supportive therapy and blood replacement; (3) cyelopropane ancsthesia. The efficiency of this routine is att,ested to bp the fact that there were no deaths among this group of severely ill patients. LOUIS M. HELLMAX
Endocrinology Oelbaum, ism,
M. I-I.: Brit. M.
The Variability J. 2: 110, 1952.
of Endocrine
Dysfunction
in Postpartum
Hypopituitar-
Vagueness and confusion regarding diagnosis and treatment in postpartum hypopituitarism still exist. Diagnostic criteria are in part to blame. Six cases due to postpart.um pituitary necrosis are described. An analysis of the biochemical findings showed marked variation in the degree of impairment of function of gonads, adrenal cortex, and ‘thyroid. The author feels that a diagnosis of mild hypopituitarism may be made even when most of the laboratory findings are normal. One of the cases described showed merely a deficient) of gonadotropin excretion, the thyroid and adrenocortical function being normal. If an early diagnosis of partial pituitary necrosis is to be made one cannot wait for all the clinical and biochemical characterizations of Simmond’s disease. Clinical features are of greater importance in the diagnosis of partial anterior pituitary failure. RALPH W. GAIJSE Lltia, cir.
J. B.: ginec.
The Third Gonad in y cancer 20: 111,1952.
a New
Scheme
of Sexual
Regularieation,
Rev.
mex.
de
The author in this paper refers to a portion of the suprdrenal cortex as the Ii third with characteristic staining gonad, ’ ’ this portion being an independent functional unit, properties. Recently this portion, which is deep and close to the medulla, has been observed to react to the hydrazine compounds similar to the 1Vketosteroida and possibly to
SELECTED
5 years or more succumbed; one patient publication. In the absence of adequate is problematic, but the author cautiously ative eases tends to be somewhat higher Definitive evidence in favor of this idea experience.
Netto,
Pedro Ayres:
ABSTRACTS
219
of the short-term group had died at the time of control material, the evaluation of these results concludes that the percentage of cure in the operthan in those patients receiving irradiation alone. would consist, of course, of a much more extensive DOUGLAS
Cancer of the Endometrium,
An.
brasil.
de ginec.
M.
HAYNES
31: 209, 1951.
The author in this paper analyses the incidence of cancer of the endometrium in his clinic at 850 Paula, and finds that among a series of 1,263 cases of cancer of the uterus, only 8 cases of cancer of the body of the uterus were found. This incidence of I:158 is below the world statistics. Etiology of corpus cancer is discussed, particularly its relation to endometrial hyperplasia and endometriosis. In the Clinic of the Institute of Viera de Carvalho among I9 cases of cancer of the endometrium only one case of endometrial hyperplasia was found. A general survey of uterine tumors observed at the clinic is reported. Among a total of 15,800 pathological examinations 1,838 uterine tumors were found: 1,263 were cancer of the cervix, 305 were fibroids, and there were 256 cases of glandular hyperplasia of the endometrium. The highest incidence of cancer of the endometrium was in the age group between 50 and 60 years, after the menopause. The author favors surgical treatment preceded by intracavitary radium, and statistics showing results of this treatment are quoted. REARDO
L.
GORBEA
Cesarean Section Pommerenke, pita&
W. T.: New
York
Cesarean Sections: State
J, Med.
52: 2785,
A Twenty-five-year
Survey in a Teaching
Ho&
1952.
The author presents the results in all of the cesarean sections performed in the twenty-five year period of its operation in the Department of Obstetrics and Gynecology of the University of Rochester. A total of 682 operations were performed, an incidence of 2.2 per cent of all deliveries. The indications for operation were numerous and varied as is the case in modern obstetrics with the general broadening of indications for this operation. The most frequent Indication was that of a previous cesarean, 13.8 per cent, closely followed by contracted pelvis, 10.4 per cent, and antepartum hemorrhage due to premature separation of the placenta, 6.6 per cent, or placenta previa, 5.0 per cent. There were 7 maternal deaths, a maternal mortality of 1 per cent, and, of these, 3 deaths were very definitely not due to the operation, but rather to underlying factors present. There were 26 (3.9 per cent) stillbirths, and 33 (5.1 per cent) neonatal deaths. Of the stillbirths, the majority were due to premature separation of the placenta which was More than half of the neonatal deaths were due to prethe indication for the operation. maturity or atelectasis. The paper is of particular interest in presenting the entire cesarean section experienee of a clinic first opened in 1926 down to the present time. KARL
M.
%‘ILSON
Ansbro, F. Paul, Gordon, Charles A., Eodell, Benson, and Latteri, Francis S.: Epidural esthesia for Cesarean Section, New York State J. Med. 52: 1901, 1952. The author first reviews the cesarean section with a comparison description of epidural anesthesia,
An-
various forms of anesthesia (general, local, spinal) for A detailed of hazards involving both mother and baby. with reasons for its use, namely, less spinal headache,
less risk of grave neurologic complications, and less fall in I~lood pressur~!s, is giver,, will1 special reference to the epidural space and an outline of the technique of epidural block. Schematic drawings illustrate by cross section the spinal column with special emphasis placed on the three ligaments to be traversed prior to reaching the epidural space. -1 phot’ograph of the necessary equipment to carry out this procedure is also shown. The results of 125 cesarean sections performed by various operators under epidural block anesthesia are discussed. No maternal mortality and no headaches were encountered. Any drop in blood pressure which occurred was usually gradual and therefore more read+ controlled. All anesthesia for the epidural block was given by trained anesthesiologists, thereby placing this form of anesthesia in a more specialized class, not for general use in all cesarcan sectious. 1:. 0. HUGHES
Ectopic Pisani,
Bernard
J.: and
Hemorrhage
Management Shock, Surg.,
Pregnancy
of &topic Pregnancy With Gynec. & Obst. 95: 149, 1952.
Massive
Intraperitoneal
In a very timely and succinct paper the author points out the need for immediate operation to control hemorrhage associated with ectopic pregnancy, even in the face of severe shock. This is contrary to the old teaching, that patients in shock should not be operated upon, but stems from one of the real surgical lessons of the last war. There were 322 patients at Bellevue operated upon for ruptured ectopic pregnancy during the last 13 years with but one death, and that due to infection. Of these, there were 35 who prr sented signs of massive intraperitoneal hemorrhage and shock. These m-ere treated as follows: (I) immediate surgery (average interval between admission and operation :;.Z hours) ; (2) concurrent supportive therapy and blood replacement; (3) cyelopropane ancsthesia. The efficiency of this routine is att,ested to bp the fact that there were no deaths among this group of severely ill patients. LOUIS M. HELLMAX
Endocrinology Oelbaum, ism,
M. I-I.: Brit. M.
The Variability J. 2: 110, 1952.
of Endocrine
Dysfunction
in Postpartum
Hypopituitar-
Vagueness and confusion regarding diagnosis and treatment in postpartum hypopituitarism still exist. Diagnostic criteria are in part to blame. Six cases due to postpart.um pituitary necrosis are described. An analysis of the biochemical findings showed marked variation in the degree of impairment of function of gonads, adrenal cortex, and ‘thyroid. The author feels that a diagnosis of mild hypopituitarism may be made even when most of the laboratory findings are normal. One of the cases described showed merely a deficient) of gonadotropin excretion, the thyroid and adrenocortical function being normal. If an early diagnosis of partial pituitary necrosis is to be made one cannot wait for all the clinical and biochemical characterizations of Simmond’s disease. Clinical features are of greater importance in the diagnosis of partial anterior pituitary failure. RALPH W. GAIJSE Lltia, cir.
J. B.: ginec.
The Third Gonad in y cancer 20: 111,1952.
a New
Scheme
of Sexual
Regularieation,
Rev.
mex.
de
The author in this paper refers to a portion of the suprdrenal cortex as the Ii third with characteristic staining gonad, ’ ’ this portion being an independent functional unit, properties. Recently this portion, which is deep and close to the medulla, has been observed to react to the hydrazine compounds similar to the 1Vketosteroida and possibly to