The active management of prolonged labor

There has been growing concern in the medical community about the rising rate of cesarean sections. Use of the modified manual rotation technique on the arrested fetal head has resulted in a decrease in the number of sections, length of hospital stay, and, consequently, the cost of care.No longer is it necessary to operate on every woman who comes to the end of the second stage of labor in the persistent occiput posterior or transverse arrest position. This technique also helps to reduce, if not eliminate, the more difficult and traumatic midforcep rotations and extractions.

Computed tomography in the evaluation of a femoral aneurysm

Computed tomography was used to delineate the extent of a distal femoral aneurysm associated with arteriomegaly.

An approach to cost-containment in health care

Economic and political repercussions throughout the nation follow the unprecedented rise in the cost of delivering health care. The physician is not only a part of the problem, but also must be an active part of the solution. The author presents an approach to cost containment in health care delivery.

Flow rate determination using computed tomography

A method of measuring flow in a large vessel by using a CT scanner is described. It has been shown that this is a simple, accurate and reproducible method in an experimental model. Possible clinical applications and limitations of this method of measuring flow are briefly considered.

Assessment of abdominal aortic aneurysms by computed tomography

Images

Gray scale ultrasonic appearances of renal transplant rejection

Ultrasonic examination of renal transplants with special attention to the parenchymal echo pattern has been undertaken in 43 patients. In the normal renal transplant, the pyramids, cortex and renal sinus can be distinguished. Renal transplant rejection is manifested by swelling and decreased echogenicity of the pyramids and hyperechogenic cortex. In addition, large anechoic areas due to hemorrhagic infarcts and necrosis are seen. In long-standing rejection, a normal or small-sized kidney with an irregular intrarenal echo pattern is observed. In 13 cases of acute tubular necrosis, none of the above appearances could be demonstrated. Serial ultrasonic scans are essential to reveal evolutionary changes of the rejection process.

Computed tomographic and ultrasonic appearances of primary carcinoma of the common bile duct

Two patients with obstructive jaundice due to surgically proved primary carcinoma of the common bile duct were examined by CT and ultrasound. The combination of the two modalities showed dilatation of the extrahepatic biliary system and the main pancreatic duct. The diagnosis of primary bile duct carcinoma is suggested by these findings in the presence of a normal pancreatic head, although similar findings may occur with a small pancreatic or ampullary carcinoma.

Grey-scale ultrasonic characteristics of carcinoma of the pancreas

Fifty-five sonograms were performed on 25 cases of surgically and histologically proven carcinoma of the pancreas. The sonographic appearances of the tumour were determined. A diffuse echogenic pattern with irregular margin was the most common appearance. Displacement and indentation of the inferior vena cava and superior mesenteric vessels, greatly assist in localizing the tumour to the pancreas. A reliable prediction of tumour size and resectability cannot be determined by sonography alone. Sonography is helpful in assessing the response of unresectable pancreatic carcinoma to therapy. A more sonolucent appearance of the tumour occurs following chemotherapy.

Teenage pregnancy, a national disaster: a significant factor in black teenage unemployment

Pregnancy is an unfortunate event in the life of preteen and teenagers. Yet, it is occurring with increasing frequency among children between the ages of 12 and 16. The magnitude of this growing problem is so great it demands the assistance of all segments of society to find a solution.While it is true that pregnancy is often a social, economic, and psychological burden to the young mother, the outlook for the baby may be even more bleak. Homes and schools are not meeting the needs for rearing and training these unplanned progeny to become productive citizens. Already, some of them are entering the labor market with few, if any, marketable skills.Preventive measures seem to offer the best prospects for dealing with this human dilemma. Since the majority of the unwed teens under discussion are black, the black physician must apply his talents and resources to finding a workable solution.

Grey scale ultrasonography in the diagnosis of ectopic pregnancy

Grey scale pelvic ultrasonography was performed in 36 patients with suspected ectopic pregnancy and in 3 with pelvic mass and bleeding. Thirteen cases were diagnosed as extrauterine pregnancy which was confirmed at operation. There were one false-positive and 2 false-negative studies. The overall diagnostic accuracy was 92.3%. The major diagnostic criteria in unruptured ectopic pregnancy were an extrauterine gestational sac or fetus and an abnormal uterine echo pattern. In addition, a complex mass due to hematoma was seen in ruptured ectopic pregnancy. Chronic ruptured ectopic pregnancy simulated pelvic inflammatory disease and was difficult to diagnose.