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Two cases of adenocarcinoma arising in extraovarian endometriosis 19 and 8 years following abdominal hysterectomy and bilateral salpingo-oophorectomy are described. Both patients presented with hydronephrosis. One had been on chronic estrogen therapy. The literature is reviewed in reference to frequency, tumor type, and sites of occurrence.

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Injury to the sciatic nerve is an infrequent but important complication of gynecologic procedures in which the lithotomy position is used. This lesion may occur after vaginal hysterectomy or after short procedures such as dilatation and curettage or laparoscopy. Few reports are found in the gynecologic literature. The authors report sciatic nerve injuries in 2 young women, one at the time of a diagnostic laparoscopy and the other during an exploratory laparotomy in which the lithotomy position was used for the purpose of tubal dye study using a Cohen cannula. Each recovered, which is consistent with previous reports. A review of the literature and possible etiologic factors is presented.

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PIP: An epidemiologic study of clear cell vaginal adenocarcinoma in young women (15-22 years old) showed an apparent association with maternal ingestion of diethylstilbestrol (DES) during 1st trimester pregnancy. In 1971, a Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Females was established, and shortly thereafter the Food and Drug Administration warned that DES and chemically related nonsteroidal estrogens were contraindicated during pregnancy. DES-exposed females have a 0.14 to 1.4/1000 risk of developing adenocarcinoma of the cervix/vagina by age 24. Diagnoses of these cancers usually are made in girls between the age of 14 and 23 years with peak incidence at age 19; data further shows that DES is an incomplete carcinogen and that additional factors contribute to its carcinogenesis. About 20% of DES-exposed women will have a deformity of the upper vagina/cervix, and approximately 95% will have abnormal columnar epithelium on the cervix/upper vagina. 75% of patients whose mothers were exposed to DES in utero during the 8th week of gestation or earlier will have vaginal adenosis; 7% will have this finding if the mother's exposure occurred after the 17th week. Recent reports also indicate a high incidence of abnormalities in the uterus/oviducts associated with gross changes in the upper vagina/cervix. Asymptomatic girls who had DES exposure in uteru should have a complete annual pelvic examination at menarche or by age 14 years. Younger girls who develop abnormal vaginal bleeding/discharge should also have a periodic thorough examination and Pap smear, as well as palpation of the entire length of the vagina/cervix. So far, cervical/vaginal adenocarcinoma has been diagnosed at initial examination, with the ratio of vaginal to cervical adenocarcinoma being almost 2:1. There is no standard therapy yet for adenocarcinoma of young women. Treatment is on a case to case basis, and prognosis depends on the stage of the disease when diagnosed.^ieng

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Eighteen women in labor received analgesia with moderately large total doses of meperidien. Various doses of naloxone (8, 12, 18, 27, 40, or 60mug/kg of body weight) were given intravenously to the mothers before delivery in an attempt to find the dose that would prevent neonatal narcotic depression. Maternal and neonatal blood gas values, Apgar scores, and postnatal neurobehavioral examinations were used to assess the effects. Infants born of mothers who had received neither meperidine, promethazine, nor naloxone served as controls. After the naloxone injection, the mothers showed an improvement in consciousness and blood gas values. When the study infants, as a group, were compared with control infants, there was very little difference in blood gas values or neurobehavioral examination. Infants in the groups receiving naloxone in doses of 18, 27, and 40mug/kg compared most favorably with the control infants, indicating that naloxone may be effective in preventing neonatal narcotic depression.

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Elective cesarean sections performed on the obstetric service at the University of Arkansas Medical Center were reviewed for the period January 1, 1970, through December 31, 1974. The purpose of the review was to compare operative and postoperative complications of cesarean section, cesarean section and tubal ligation, and cesarean section and elective hysterectomy. A total of 1,255 cesarean sections were performed of which 207 (17 per cent) were associated with tubal ligation and 242 (18 per cent) with hysterectomy. Elective cesarean hysterectomies were performed for elective sterilization (68 per cent), for medically indicated sterilizations (11 per cent), or for definitive treatment of uterine pathology(21 per cent). All cesarean sections were obstetrically indicated with the exception of 34 primary cesarean hysterectomies performed as definitive treatment of carcinoma in situ of the cervix. The operative procedures were compared in regard to the following characteristics or complications: operating time; incidence of blood transfusions, urinary tract injuries, postoperative bleeding, febrile morbidity, and other postoperative complications; and postoperative hospital days.

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Continuous lumbar extradural analgesia with mepivacaine was administered to two groups of patients in normal labour. One group (26 patients: 1% mepivacaine) received a mean total dose of 342 mg (4.93 mg/kg) per patient, and developed a mean blood concentration of mepivacaine at delivery of 1.82 mug/ml. The neonatal umbilical vein concentration was 0.84 mug/ml. The other group (30 patients: 2% mepivacaine) received a mean total dose of 776 mg (11.65 mg/kg) per patient, and developed a mean blood concentration of mepivacaine at delivery of 3.47 mug/ml. The neonatal umbilical vein concentration was 2.61 mug/ml. Four of the infants of mothers who received 1% mepivacaine were depressed (1-min Apgar score 6 or less), and six of the other group were depressed also. Usually, depression appeared to be related to obstetric factors, rather than to analgesia. Eleven of the 56 infants had umbilical vein mepivacaine concentrations of 3 mug/ml or greater; of these, three were depressed. This does not agree with the concept that the toxic threshold for mepivacaine is 3 mug/ml. In both groups a significant linear correlation was obtained between umbilical vein concentration and total dose of mepivacaine. A maximal dose of 12 mg/kg maternal weight in the non-obese or 12 mg/kg lean body mass in the obese is suggested for continuous extradural analgesia with mepivacaine, although healthy mothers and infants may tolerate much more.

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The purpose of this study was to determine the long-term effect of Schauta hysterectomy on bladder function as determined by serial cystometric studies. The maximum bladder capacity, resting pressure at maximum capacity, and volume of residual urine were determined preoperatively, postoperatively, at time of final catheter removal, and one or more years after surgery. A prior report showing that the bladder decreased in capacity, increased in tone, and, emptied poorly if at all postoperatively was confirmed. The mean duration of postoperative catheter drainage in 68 patients was 33 days. One year or more after surgery the mean maximum bladder capacity had returned to the preoperative volume; persistent elevation of the mean resting pressure was significant in the pooled but not in the paired data; the mean residual urine volume of 25 ml. was significantly elevated. The assumption was that maintenance of intrinsic detrusor muscle tone by prevention of overdistention preserved balanced bladder function. Many patients initiated and maintained micturition by voluntary straining or by use of Crede's maneuver although others voided relatively normally. Presumably these bladders are denervated to varying degrees, producing a spectrum of functional disturbance. The "bladder-conscious" patient can protect and preserve bladder function but these bladders appear to remain vulnerable to infection and overdistention, perhaps permanently.

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PIP: Questionnaires were sent to 54 members of the New Orleans Gynecological and Obstetrical Society to determine how many local obstetricians were using IUDs and with what results. 24 of the 44 responding physicians had been inserting either a Lippes loop, a Margulies spiral, or a Saf-T-Coil for 6 to 48 months. Out of an approximate total of 1000 women there were 20 reported pregnancies (6 with the loop and 7 each with the spiral and coil) constituting a pregnancy rate of 1.4 per 100 woman years. In almost half of the cases the interval from insertion to pregnancy was 1 year or more. Of the 20 pregnancies, 1 was lost to followup, 5 were still in progress, 3 had been terminated by spontaneous abortion, and 1 had been terminated by cesarean section for cephalopelvic disproportion. There were no reported complications in the other pregnancies.^ieng

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