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Rupture of ovarian blood-cysts simulating acute appendicitis
98
AMERICAN
JOURNAL
OF
OBSTETRICS
SND
GYNECOLOGY
the conclusion that in this case a gaseous exchange took place betwren the atmospheric air on the one hand, and the blood circulating through the capillaries of the chorionic villi on the other. The cause of the premature labor was not aseertainrd but tho gross appearance of the placenta indicated no abnormality in its structure nor any disease of its tissues, and though generalizations are hazardous it seems justifiable to suppose that any normal placenta under similar ronditions might function in t,he same manner. Schumacher3 in his paprr points out the importance of the placental blood in improving the prognosis in asphyxia or of threatened asphyxia of the newborn, and shows the value of his observations in supplying a hitherto unrecognized reason for not clamping the cord in such cases while the circulation continues through it, and also in pointing out the importance of starting artificial respiration before compressing the umbilical vessels. SUMMARY
1. The passage of oxygen through the walls of the chorionic villi from the maternal to the fetal blood and of carbon dioxide from the fetal to the maternal blood have long been accepted by physiologists as proved phenomena. 2. That the same interchange of gases may occur between the fetal blood and the atmospheric air after det.achment of the placenta from the uterine wall is not so widely recognized. 3. A case is reported in which the assumption of such a gaseous interchange is requisite to a rational explanation of the sequence of eTents in the case history. 4. This function of the detached placenta may have a practical application in the treatment and prevention of some cases of asphyxia neonatorum. REFERENCES
(1) DeLee, Joseph B. : Principles and Practice of Obstetrics, ed. 4, Philadelphia, W. B. Saunders Co. (2) Howe& JYilliam H.: Textbook of Physiology, ed. 10, Philadelphia, W. B. Saunders Co. (3) S c h umacher, H. : Miinchen. med. Wchnschr. 77 : 313, 1930. (4) Queries and Minor Notes, J. A. M. A. 95: 1039, 1930. 1422
MEDICAL
ARTS
BUILDIKG.
Boggan, R. H., and Wrigley, Acute Appendicitis. Lancet
A. J.: 221:
Rupture 1068, 1931.
of Ovarian
Blood-Cysts
Simulating
The authors report 13 cases of this condition, the right ovary was affected in They imply that the ov:tri:ln hemorrhage is an exaggeration of the normal ten. physiologic mechanism of the rupture of the Graafian follicle. The essential diag nostic differences favoring ruptured ovarian blood-cyst are: the sudden onset of severe lower abdominal pain in relation to slight trauma; the good general condition of patient in spite of its duration; and marked lower abdominal tenderness without marked muscular rigidity. They advise exploratory laparotomy if the diagnosis is uncertain (usually) and recommend at operation enucleation of the hemorrhagic area. II. CLOSE HESSELTINE.
AMERICAN
JOURNAL
OF
OBSTETRICS
SND
GYNECOLOGY
the conclusion that in this case a gaseous exchange took place betwren the atmospheric air on the one hand, and the blood circulating through the capillaries of the chorionic villi on the other. The cause of the premature labor was not aseertainrd but tho gross appearance of the placenta indicated no abnormality in its structure nor any disease of its tissues, and though generalizations are hazardous it seems justifiable to suppose that any normal placenta under similar ronditions might function in t,he same manner. Schumacher3 in his paprr points out the importance of the placental blood in improving the prognosis in asphyxia or of threatened asphyxia of the newborn, and shows the value of his observations in supplying a hitherto unrecognized reason for not clamping the cord in such cases while the circulation continues through it, and also in pointing out the importance of starting artificial respiration before compressing the umbilical vessels. SUMMARY
1. The passage of oxygen through the walls of the chorionic villi from the maternal to the fetal blood and of carbon dioxide from the fetal to the maternal blood have long been accepted by physiologists as proved phenomena. 2. That the same interchange of gases may occur between the fetal blood and the atmospheric air after det.achment of the placenta from the uterine wall is not so widely recognized. 3. A case is reported in which the assumption of such a gaseous interchange is requisite to a rational explanation of the sequence of eTents in the case history. 4. This function of the detached placenta may have a practical application in the treatment and prevention of some cases of asphyxia neonatorum. REFERENCES
(1) DeLee, Joseph B. : Principles and Practice of Obstetrics, ed. 4, Philadelphia, W. B. Saunders Co. (2) Howe& JYilliam H.: Textbook of Physiology, ed. 10, Philadelphia, W. B. Saunders Co. (3) S c h umacher, H. : Miinchen. med. Wchnschr. 77 : 313, 1930. (4) Queries and Minor Notes, J. A. M. A. 95: 1039, 1930. 1422
MEDICAL
ARTS
BUILDIKG.
Boggan, R. H., and Wrigley, Acute Appendicitis. Lancet
A. J.: 221:
Rupture 1068, 1931.
of Ovarian
Blood-Cysts
Simulating
The authors report 13 cases of this condition, the right ovary was affected in They imply that the ov:tri:ln hemorrhage is an exaggeration of the normal ten. physiologic mechanism of the rupture of the Graafian follicle. The essential diag nostic differences favoring ruptured ovarian blood-cyst are: the sudden onset of severe lower abdominal pain in relation to slight trauma; the good general condition of patient in spite of its duration; and marked lower abdominal tenderness without marked muscular rigidity. They advise exploratory laparotomy if the diagnosis is uncertain (usually) and recommend at operation enucleation of the hemorrhagic area. II. CLOSE HESSELTINE.