Summary
The histological and cytological assessment of material obtained with an intrauterine jet washing device from 138 patients with postmenopausal bleeding, abnormal premenopausal bleeding or infertility is presented. In the first part of the study 55 washings were examined by histological techniques and the findings compared with those in material subsequently obtained by curettage or endometrial biopsy. Only 32 (58 per cent) of the washings were satisfactory for evaluation of the endometrium compared with 46 (84 per cent) of the curettings. When, in the second part of the study the washings in 83 cases were examined by both histological and cytological methods, 76 (92 per cent) were satisfactory compared with 59 (71 per cent) of the curettings. Cytological examination of the washings in the postmenopausal women provided a significantly higher proportion of satisfactory specimens than histological examination alone or evaluation of the curettings. In the whole study, three cases of endometrial carcinoma were diagnosed by endometrial washings and by curettage, while in six cases of endometrial hyperplasia one false negative was obtained by histological examination of the washings and one by examination of the curettings. This study shows that endometrial samples obtained with the intrauterine jet washer provide information about the endometrium which is comparable with that obtained by conventional curettage, and also that in postmenopausal women endometrial lavage may be more reliable than curettage.
Summary
One hundred and six samples of amniotic fluid were analyzed independently by four clinicians for surfactant content, using the shake test and the palmitic acid content of the amniotic fluid. The variation of the results in the 424 shake tests were examined and the shake tests correlated with the palmitic acid levels. A positive shake test to a dilution of 1:4 had a 100 per cent correlation with a mature palmitic acid level over 35 pg./ml., while a positive test at a dilution 1:2 gave a 5.6 per cent false positive rate. A high false negative rate was found, however, and estimates of the chance of a mature surfactant level in relation to the range of shake tests results are given. Eleven patients had low palmitic acid levels in the amniotic fluid prior to delivery and three of the infants developed the respiratory distress syndrome.
Summary: Four cases of bleeding from the splenic artery associated with pregnancy are presented. Rupture of a splenic artery aneurysm is a rare and extremely dangerous condition and the premonitory symptoms, if any, are common in pregnancy and easily dismissed. Initial collapse is often transient and may be followed by apparent recovery, giving a false sense of security. Successful treatment depends on recognition, restoration of blood volume, and ligation of the bleeding artery. Exploration of the abdomen is essential in any patient with suspected intra‐abdominal bleeding.
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