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Blood volume adjustment to shock in dogs
Volume 88
Selected abstracts 561
Number4
thalamus appears to exert its control over LH secretion by means of a humoral substance des· ignated luteinizing hormone releasing factor ( LH-RF), which is released into the hypophysial portal vessels and triggers the discharge of LH by an action on the hypophysis itself. Large doses of ovarian steroids, alone and in combination, failed to inhibit a response to ( SME) stalk median eminence extract. Therefore, it was concluded that ovarian steroids cannot block the hypophysial response to LH-RF. Presumably the action of the ovarian steroids is mediated at some other site. The nature of LH-RF is unknown, but it may be a polypeptide related to the known neurohypophyseal hormones. It is hoped that if LH-RF can be synthesized its value can be extrapolated to induce ovulation in women with hypothalamic dysfunction. Harrison H. Sheld
American Journal of the Medical Sciences Vol. 244, 1962. *Gordon, H. H.: The Infants of Diabetic Mothers, p. 129. *Greene, J. W., Jr., Touchstone, J. C., and Fields, H.: Estrogen Excretion as an Index of Placental Function. A Review, p. 756. Gordon: Infants of Diabetic Mothers, p. 129. One hundred and four pregnant women with diabetes were seen at the Sinai Hospital of Baltimore between 1947 and 1960; the frequency was 2.3 per 1,000 admissions. Fifteen babies were stillborn and 4 died shortly after birth, a perinatal mortality rate of 18 per cent. Macrosomia is common, and 54 per cent of the infants' birth weights exceeded the seventy-fifth percentile for liveborn infants; maturation of various organs correlates with the gestational age rather than with the birth weight. Many infants have plethoric, bloated faces; although this has been described as a "Cushingoid syndrome," there appears to be no correlation with plasma 17-hydroxysteroid levels in maternal or cord blood. Approximately half the infants bom to mothers with diabetes have early hypoglycemia, which may be related to apnea, cyanosis, limpness, pallor, tremors, convulsions, and conceivably to later neurologic deficits. Tachypnea was noted in 15 to 37 infants or in 40 per cent of those observed in this respect. The respiratory difficulties may have 3 bases: (I) prematurity (poor gag and cough reflexes, soft rib cage, poor muscle tone, underdevelop-
ment of pulmonary capillaries, and lack of lung surfactant, which increases the tendency to atelectasis), (2) cesarean section (preoperative medication, anesthesia, and lack of vaginal compression) and ( 3) effects of maternal diabetes (low pH, hypercapnia, low oxygen tension, and edema). Leon C. Chesley
Greene, Touchstone, and Fields: Estrogen Excre· tion as Index of Placental Function, p. 756. The authors review earlier work in which a low or falling urinary excretion rate of estriol has been correlated with placental dysfunction. They have made 2,000 measurements in 279 pregnancies. When the maternal urinary estriol excretion rate was more than 12 mg. per 24 hours, within 24 hours of delivery, no fetal death occurred, except in instances of erythroblastosis fetalis. During the third trimester, no fetus survived for more than 2 days when the mother excreted less than 4 mg. of estriol in 24 hours. When excretions were between 4 and 12 mg., no fetal death occurred, but 10 babies died in the neonatal period. Of twenty-six infants, who were delivered because of a falling estriol excretion, all survived. It is suggested that daily measurements of estriol excretion be made in women in whom pregnancy is complicated by diseases that jeopardize the fetus; a drop of the titer to low levels would indicate that the pregnancy should be terminated to forestall fetal death. Leon C. Chesley
Archives of Surgery Vol. 86, Jan., 1963. *Dobemeck, R. C., Johnson, D. G., and Harda· way, R. M.: Blood Volume Adjustment to Shock in Dogs, p. 267. Dobemeck, Johnson, and Hardaway: Blood Vol· ume Adjt5tment to Shock in Dogs, p. 267. Predicted and actual blood volumes were determined in dogs before, during, and following experimental hemorrhagic or endotoxic shock, with the use of the radioactive Jl 31 -labeled serum albumin (RISA) technique. Dogs which survived hemorrhagic shock had blood volumes greater than were anticipated during the hypotensive period. All dogs had blood volumes less than were anticipated after the reinfusion of removed blood. In those dogs subjected to endotoxic shock by injection of Esche·
562
Selected abstracts
richia coli endotoxin, there were minimal alterations in effective blood volunte. Changes in effective blood volume are attributed to a balance between sequestration of both plasma and erythrocytes on the one hand, and hemodilution by entry of f'Xtravascular fluid into thi' circulation on the other. Edward E. H'allach
British Medical Journal March 30, 1963. *Littlewood, ]. M.: Polycythaemia and Anaemia in Newborn Monozygotic Twin Girls, p. 857. Littlewood: Polycythaemia and Anaemia in Newborn Monozygotic Twin Girls, p. 85 7. A case of monozygotic twins is reported, with one twin having anemia and the other polycythemia at birth. Hemoglobin levels were 7.8 Gm. (5:Z per cent) and 25.6 Gm. ( 175 per cent), respectively. Treatment consisted of transfusion of the infant with anemia and exchangP transfusion of the baby with polycythemia bPcausc of the development of hyperbilirubinemia. One portion of the placenta was deeply congested while the other portion was pale. Both twins appPared to be normal at the age of 10 weeks. Vascular anastomoses bet\veen thP two parts of thr monozygotic twin placentas are suggested as an explanation of the phrnomenon. Edward E. H'allach
April 20, 1963. *Fulthorpe, A. J., Parke, J. A. C., Tovey, J. E., and Monckton, ]. C.: Pregnancy Diagnosis by a One-stage Passive Harma,g-glutination Inhibition MPthod, p. 1049. Fulthorpe et al: Pregnancy Diagnosis by a One· stage Passive Haemagglutination Inhibition Method, p. 1049. An immunological test for pregnancy based on one-stPp hl"magglutination inhibition is drscribrd. Antiserum was obtained by the immunization of rabbits with human chorionic gonadotrophin ( HCG). ShePp erythrocytes wrre sPnsi tized to HCG. Hemagglutination inhibition tests were carried out with the use of morning specimens of urine from women believed to be pregnant. Results were also compared with those obtained by the male toad test. Of 126 clinically confirmed pregnancies, 124 wrre positive by the immunological test. When tests were carried out to compare rPsults with thosp obtainPd hy the male toad test, over-all
Am .
February 15, 1964 Obst. & Gynrc.
.J.
accuracy of the hemagglutination inhibition method \\ as 98.2 per cent, and that of the rnale toad test, 92.8 per cent. A quantitative assay was not as satisfactory as it was when the test was used for pregnancy diagnosis. Satisfactory results were obtained on sera of pregnant and nonpregnant women provided that nonspecific agglutinins and inhibitors were removed. Edward E. IV allach 1
April 27, 1963. *Crooke, A. C., Butt, W. R., Palmer, R., Morris, F... , Ed\"/ards, F.... L., Taylor, C. W., and Short, R. V.: Effect of Human Pituitary-follicle-stimulating Hormone and Chorionic Gonadotrophin in Stein-Lcventhal Syndrome, p. 1119. Crooke et al: Effect of Human Pituitary-folliclestimulating Hormone and Chorionic Gonadotrophin in Stein-Leventhal Syndrome, p. 1119. Five patit>nts with a diagnosis of the Stein-Leventhal syndrome were treated with a combination of follicle-stimulating hormone (FSH) and chorionic gonadotrophin ( HCG). Estriol and pregnanediol determinations were performed upon 48 hour urine specimens. Cyst fluid and luteal tissur obtained at the time of laparotomy werP analyzed for steroid content by the method of Short. Threr of the patients were treated with dexamethasone to inhibit adrenocortic:ostProid production. Excretion of Pstriol increased about threefold in ·4 of the patients following the initial injection of FSH. The estriol and pregnanediol rxcretion rose in all patients following thr serond dos" of FSH and HCG. There was generally good a,Q;reenwnt between thP daily excretion of urinary steroids and their concentration in thP ovarian cysts and luteal tissue. Little androstenPdione \vas found in the cyst fluid. Th!' author~ suggP~t that surgical wedge resection of thr ovaries may be successful on the basis of drstrurtion of a sufficient number of cystic folliclrs to altrr thl' abnormal hormone spcretion. Thrre i~ a possibility that treatment with gonadotrophins may accomplish the samP rf'sults. Edward E. ~Vallach Iune 22. 1963. *MacGr('gor, .J. E., and Baird, D.: Detection of Cervical Carcinoma in thP GPnera] Population, p. 16::\1.
Selected abstracts 561
Number4
thalamus appears to exert its control over LH secretion by means of a humoral substance des· ignated luteinizing hormone releasing factor ( LH-RF), which is released into the hypophysial portal vessels and triggers the discharge of LH by an action on the hypophysis itself. Large doses of ovarian steroids, alone and in combination, failed to inhibit a response to ( SME) stalk median eminence extract. Therefore, it was concluded that ovarian steroids cannot block the hypophysial response to LH-RF. Presumably the action of the ovarian steroids is mediated at some other site. The nature of LH-RF is unknown, but it may be a polypeptide related to the known neurohypophyseal hormones. It is hoped that if LH-RF can be synthesized its value can be extrapolated to induce ovulation in women with hypothalamic dysfunction. Harrison H. Sheld
American Journal of the Medical Sciences Vol. 244, 1962. *Gordon, H. H.: The Infants of Diabetic Mothers, p. 129. *Greene, J. W., Jr., Touchstone, J. C., and Fields, H.: Estrogen Excretion as an Index of Placental Function. A Review, p. 756. Gordon: Infants of Diabetic Mothers, p. 129. One hundred and four pregnant women with diabetes were seen at the Sinai Hospital of Baltimore between 1947 and 1960; the frequency was 2.3 per 1,000 admissions. Fifteen babies were stillborn and 4 died shortly after birth, a perinatal mortality rate of 18 per cent. Macrosomia is common, and 54 per cent of the infants' birth weights exceeded the seventy-fifth percentile for liveborn infants; maturation of various organs correlates with the gestational age rather than with the birth weight. Many infants have plethoric, bloated faces; although this has been described as a "Cushingoid syndrome," there appears to be no correlation with plasma 17-hydroxysteroid levels in maternal or cord blood. Approximately half the infants bom to mothers with diabetes have early hypoglycemia, which may be related to apnea, cyanosis, limpness, pallor, tremors, convulsions, and conceivably to later neurologic deficits. Tachypnea was noted in 15 to 37 infants or in 40 per cent of those observed in this respect. The respiratory difficulties may have 3 bases: (I) prematurity (poor gag and cough reflexes, soft rib cage, poor muscle tone, underdevelop-
ment of pulmonary capillaries, and lack of lung surfactant, which increases the tendency to atelectasis), (2) cesarean section (preoperative medication, anesthesia, and lack of vaginal compression) and ( 3) effects of maternal diabetes (low pH, hypercapnia, low oxygen tension, and edema). Leon C. Chesley
Greene, Touchstone, and Fields: Estrogen Excre· tion as Index of Placental Function, p. 756. The authors review earlier work in which a low or falling urinary excretion rate of estriol has been correlated with placental dysfunction. They have made 2,000 measurements in 279 pregnancies. When the maternal urinary estriol excretion rate was more than 12 mg. per 24 hours, within 24 hours of delivery, no fetal death occurred, except in instances of erythroblastosis fetalis. During the third trimester, no fetus survived for more than 2 days when the mother excreted less than 4 mg. of estriol in 24 hours. When excretions were between 4 and 12 mg., no fetal death occurred, but 10 babies died in the neonatal period. Of twenty-six infants, who were delivered because of a falling estriol excretion, all survived. It is suggested that daily measurements of estriol excretion be made in women in whom pregnancy is complicated by diseases that jeopardize the fetus; a drop of the titer to low levels would indicate that the pregnancy should be terminated to forestall fetal death. Leon C. Chesley
Archives of Surgery Vol. 86, Jan., 1963. *Dobemeck, R. C., Johnson, D. G., and Harda· way, R. M.: Blood Volume Adjustment to Shock in Dogs, p. 267. Dobemeck, Johnson, and Hardaway: Blood Vol· ume Adjt5tment to Shock in Dogs, p. 267. Predicted and actual blood volumes were determined in dogs before, during, and following experimental hemorrhagic or endotoxic shock, with the use of the radioactive Jl 31 -labeled serum albumin (RISA) technique. Dogs which survived hemorrhagic shock had blood volumes greater than were anticipated during the hypotensive period. All dogs had blood volumes less than were anticipated after the reinfusion of removed blood. In those dogs subjected to endotoxic shock by injection of Esche·
562
Selected abstracts
richia coli endotoxin, there were minimal alterations in effective blood volunte. Changes in effective blood volume are attributed to a balance between sequestration of both plasma and erythrocytes on the one hand, and hemodilution by entry of f'Xtravascular fluid into thi' circulation on the other. Edward E. H'allach
British Medical Journal March 30, 1963. *Littlewood, ]. M.: Polycythaemia and Anaemia in Newborn Monozygotic Twin Girls, p. 857. Littlewood: Polycythaemia and Anaemia in Newborn Monozygotic Twin Girls, p. 85 7. A case of monozygotic twins is reported, with one twin having anemia and the other polycythemia at birth. Hemoglobin levels were 7.8 Gm. (5:Z per cent) and 25.6 Gm. ( 175 per cent), respectively. Treatment consisted of transfusion of the infant with anemia and exchangP transfusion of the baby with polycythemia bPcausc of the development of hyperbilirubinemia. One portion of the placenta was deeply congested while the other portion was pale. Both twins appPared to be normal at the age of 10 weeks. Vascular anastomoses bet\veen thP two parts of thr monozygotic twin placentas are suggested as an explanation of the phrnomenon. Edward E. H'allach
April 20, 1963. *Fulthorpe, A. J., Parke, J. A. C., Tovey, J. E., and Monckton, ]. C.: Pregnancy Diagnosis by a One-stage Passive Harma,g-glutination Inhibition MPthod, p. 1049. Fulthorpe et al: Pregnancy Diagnosis by a One· stage Passive Haemagglutination Inhibition Method, p. 1049. An immunological test for pregnancy based on one-stPp hl"magglutination inhibition is drscribrd. Antiserum was obtained by the immunization of rabbits with human chorionic gonadotrophin ( HCG). ShePp erythrocytes wrre sPnsi tized to HCG. Hemagglutination inhibition tests were carried out with the use of morning specimens of urine from women believed to be pregnant. Results were also compared with those obtained by the male toad test. Of 126 clinically confirmed pregnancies, 124 wrre positive by the immunological test. When tests were carried out to compare rPsults with thosp obtainPd hy the male toad test, over-all
Am .
February 15, 1964 Obst. & Gynrc.
.J.
accuracy of the hemagglutination inhibition method \\ as 98.2 per cent, and that of the rnale toad test, 92.8 per cent. A quantitative assay was not as satisfactory as it was when the test was used for pregnancy diagnosis. Satisfactory results were obtained on sera of pregnant and nonpregnant women provided that nonspecific agglutinins and inhibitors were removed. Edward E. IV allach 1
April 27, 1963. *Crooke, A. C., Butt, W. R., Palmer, R., Morris, F... , Ed\"/ards, F.... L., Taylor, C. W., and Short, R. V.: Effect of Human Pituitary-follicle-stimulating Hormone and Chorionic Gonadotrophin in Stein-Lcventhal Syndrome, p. 1119. Crooke et al: Effect of Human Pituitary-folliclestimulating Hormone and Chorionic Gonadotrophin in Stein-Leventhal Syndrome, p. 1119. Five patit>nts with a diagnosis of the Stein-Leventhal syndrome were treated with a combination of follicle-stimulating hormone (FSH) and chorionic gonadotrophin ( HCG). Estriol and pregnanediol determinations were performed upon 48 hour urine specimens. Cyst fluid and luteal tissur obtained at the time of laparotomy werP analyzed for steroid content by the method of Short. Threr of the patients were treated with dexamethasone to inhibit adrenocortic:ostProid production. Excretion of Pstriol increased about threefold in ·4 of the patients following the initial injection of FSH. The estriol and pregnanediol rxcretion rose in all patients following thr serond dos" of FSH and HCG. There was generally good a,Q;reenwnt between thP daily excretion of urinary steroids and their concentration in thP ovarian cysts and luteal tissue. Little androstenPdione \vas found in the cyst fluid. Th!' author~ suggP~t that surgical wedge resection of thr ovaries may be successful on the basis of drstrurtion of a sufficient number of cystic folliclrs to altrr thl' abnormal hormone spcretion. Thrre i~ a possibility that treatment with gonadotrophins may accomplish the samP rf'sults. Edward E. ~Vallach Iune 22. 1963. *MacGr('gor, .J. E., and Baird, D.: Detection of Cervical Carcinoma in thP GPnera] Population, p. 16::\1.