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Pharmacological agents in experimental hemorrhage
834
Selected
abstracts
111 appears limited to t.ht. parametria not cxtcnd to the side walls, it would
and doe& be classified
;LS a late Stagr II in this country, if thp picture is taken literally. Similarly, unless the vaginal I&on in the Stage I’\’ diagram is taken to c,xtend beyond the vaginal wall itself, it would br classified as Stage III. The bibliography is caxtensivc and current. including referencrs. mostly German of (‘ours,‘. only sincr 1953. For earlier publications on the subject the reader is refrrrrd to thr \cacond rdition of the hook. Thr subject indrx i?: concisca and accuratr. Evaluation of the Atlas as a wholr presents c.r‘rtain inherent difficulties. The work is probabl! thr bc~t available one on the subject, by authors who arr both dedicated and rxpcrienccd. Unfortunately. a distorted vip\c of thr importances
of colposcopy in the detection of cL;tr1) c csrvical carcinoma is presented, assipning to the Papanicolaou smear a secondary or, at best, an equal role. The common conclusion is that ultimate diagnosis rests on biops!, and thr authors gratifyingly emphasize the superiority of the small cone over random cervical biopsies. A copy of this book would be appropriate in any pathologic laboratory or departmental library. although not office of c’vcry American nraccssarily in the gynecologist. That tion to the field of After a careful text, howcv(Br, one frpling of a drama witnessed a first-ratts rate work
thr book is a great contribucolposcopy thcrc is no doubt. and objective reading of the Cs lrft with thr ambivalent or music critic. who has just pprformancc of a sccond-
Ralph M. LVvnn
Selected abstracts Archives of Surgery 6’01. 83, No. 3. September,
1961.
.‘Hakstian.
R. W., Hampson, F. N.: Pharmacological pprimental Hemorrhage,
Hakstian,
Hampson, and Gurd: Pharmacological Agents in Experimental Hemorrhage,
p. 335. Hydralazine (an adrenergic hydrocortisone, and levarterenol rine) werr evaluated with
I,.
G., and Gurd. Agents in Exp. 335.
blocking agent ! (l-norepinephrespect to theit
rffectivenrss in combating experimental hemorrhagic shock. Pervious experiments had indicated that drugs which block the vascular response. to both circulating adrenergic substances and to nerve activity, like Dibenamine, protected animals against the shock resulting from blood volume reduction. The favorable effect of the adrenergic blocking agents may be due to the improved perfusion of tissues, the improved distribution of available blood, and possibly to support of the plasma volume by some effect on the capillary membranes. There is a natural reluctance, however. to use agents which may lower the blood pressure: still further in treatment of severe shock.
.4mong the steroid hormones, hydrocortisone, which demonstrates certain properties of both mineralocorticoids and glucocorticoids, is thtx most effective in restoring the blood pressure in rases of hemorrhagic hypotension. The tentative suggestion was made that hydrocortisone in large doses may possess an adrenergic blocking action, as indicated by the protection offered in shock due to endotoxins and to epinephrine. The present Fxperiments compared the effecta of hydralaxine, hydrocortisone, and I-norepinrphrine reversible rontrols
in preventing hemorrhagic wrrc used in
the shock each
development of irin dogs. Untreated group and showed
a 100 per cent mortality. ,4utopsy findings in the animals which died included. severe necrotic lesions in the bowel. Of the animals receiving hydralazine, 94 per cent of 16 survived. In the hydrocortisonp-treated group, 85 per cent survived. In the I-norepinephrine-treated group, only 23 per cent of 13 survived. Hydralazine (Apresoline) acts as an antihypertensive both centrally on the vasomotor center and peripherally as an adrenergic blocking agent. It may increase renal blood flow and possibly stimulate cardiac action. The drug affords an excellent protection against the irreversibility of shock. Pathologic evidence of decrease in the
Volume Number
84 ti
Selected
severity of bowel lesions may indicate that one area of augmented blood flow was somewhere within the portal bed. The question remains whether the obvious protection of the vital tissues is a result of specific selective improvement in organ perfusion or is secondary to increased venous return to the heart. A drug like dibenzyline may be of value in unmasking oligemia; that is, a fall in blood pressure following administration of the drug means that volume replacement has been inadequate. With hydrocortisone, but not with hydralazine, there is the suggestion of a relative increase in plasma volume. No evidence of an adrenergic block was found with hydrocortisone in the present experiments. The point is stressed that both hydrocortisone and hydralazine are ineffective in treating irreversible shock, but they are important in preventing its development. They must, consequently, be given prior to the development of irreversibility. Norepinephrine offered no significant protection against the development of irreversible shock. Laboratory experiments suggest, on the contrary, that it may render the shocked animal unresponsive to the effects of subsequent transfusion. The present investigators feel that the adrenergic blocking agents have a place as a therapeutic adjunct to blood volume replacement in hemorrhagic shock. The desirable effects may result from a moderation of the intensity of vasoconstriction and a decrease in visceral damage due to anoxia. A shift in emphasis from the sole aim of returning the blood pressure to normal is suggested, with more attention paid to promoting adequate perfusion of tissues. The action of hydrocortisone remains obscure; and norepinephrine in hemorrhagic shock may actually increase peripheral anoxia. The final suggestion is offered that most favorable results may be obtained by appropriate combinations of the three classes of drugs discussed in the paper. Ralph M. Wynn Yo.
4, October,
1961.
*Boles, E. T., Jr., Hardacre, J. M., and Newton, W. A.: Ovarian Tumors and Cysts in Infants and Children, p. 580. Boles, Hardacre, and Newton: Ovarian Tumors and Cysts in Infants and Children, p. 580. Sixteen cases of ovarian tumors in infants and children. representing 10 years’ experience
abstracts
835
at the Columbus Children’s Hospital in Ohio, are reviewed. The ovarian growths are divided into three categories: the first group includes granulosa cell tumors, dysgerminomas, cystadenomas, and embryonal carcinomas, which are improperly classified as ovarian stromal growths; the second group comprises teratomas, the third consists of nonneoplastic cysts. In this series, there were 8 teratomas, 2 malignant tumors (1 embryonal carcinoma and 1 granulosa cell tumor), and 6 nonneoplastic cysts. Ovarian tumors in children present the following signs and symptoms: (1) abdominal mass, (2) abdominal pain, and (3) sexual precocity. The first case report concerns a 5-yearold with a granulosa cell tumor, in whom signs of sexual precocity regressed following unilateral salpingo-oophorectomy. The second case is that of a 15-year-old girl with an embryonal carcinoma, who at laparotomy was found to have generalized metastases and who died one month postoperatively. Although carcinoma of the ovary in children is rare in general, it is more frequently solid than in adults. Whereas less than 3 per cent of all ovarian carcinoma occurs below the age of 20, 10 per cent of all solid ovarian cancer occurs below this age. In this connection, the scarcity of cystadenomas in the child is stressed. Teratomas, the most common ovarian neoplasms of childhood, are usually benign and cystic, although a higher proportion are solid than in the adult. In this series all tumors of this variety were treated by unilateral oophorectomy or salpingo-oophorectomy and all patients did well postoperatively. Of the 6 patients with nonneoplastic cysts, 2 were subjected to laparotomy with the preoperative diagnosis of appendicitis. In one infant, torsion of the pedicle of a large ovarian mass created an acute abdominal condition. Another infant presented with abdominal distention caused by large bilateral corpus luteum cysts. In 2 cases nonneoplastic cysts were associated with sexual precocity. Mention is made of a &year-old who underwent a left salpingooophorectomy for a 5 cm. Graafian follicle ryst. This child had breast development, pubic hair, and a cornified vaginal smear; following operation all these signs regressed. A 2%yearold patient is described who demonstrated polyostotic fibrous dysplasia, flat areas of brownish pigmentation of the skin, and sexual precocity ( McCune-Alhright syndrome=). The pres-
Selected
abstracts
111 appears limited to t.ht. parametria not cxtcnd to the side walls, it would
and doe& be classified
;LS a late Stagr II in this country, if thp picture is taken literally. Similarly, unless the vaginal I&on in the Stage I’\’ diagram is taken to c,xtend beyond the vaginal wall itself, it would br classified as Stage III. The bibliography is caxtensivc and current. including referencrs. mostly German of (‘ours,‘. only sincr 1953. For earlier publications on the subject the reader is refrrrrd to thr \cacond rdition of the hook. Thr subject indrx i?: concisca and accuratr. Evaluation of the Atlas as a wholr presents c.r‘rtain inherent difficulties. The work is probabl! thr bc~t available one on the subject, by authors who arr both dedicated and rxpcrienccd. Unfortunately. a distorted vip\c of thr importances
of colposcopy in the detection of cL;tr1) c csrvical carcinoma is presented, assipning to the Papanicolaou smear a secondary or, at best, an equal role. The common conclusion is that ultimate diagnosis rests on biops!, and thr authors gratifyingly emphasize the superiority of the small cone over random cervical biopsies. A copy of this book would be appropriate in any pathologic laboratory or departmental library. although not office of c’vcry American nraccssarily in the gynecologist. That tion to the field of After a careful text, howcv(Br, one frpling of a drama witnessed a first-ratts rate work
thr book is a great contribucolposcopy thcrc is no doubt. and objective reading of the Cs lrft with thr ambivalent or music critic. who has just pprformancc of a sccond-
Ralph M. LVvnn
Selected abstracts Archives of Surgery 6’01. 83, No. 3. September,
1961.
.‘Hakstian.
R. W., Hampson, F. N.: Pharmacological pprimental Hemorrhage,
Hakstian,
Hampson, and Gurd: Pharmacological Agents in Experimental Hemorrhage,
p. 335. Hydralazine (an adrenergic hydrocortisone, and levarterenol rine) werr evaluated with
I,.
G., and Gurd. Agents in Exp. 335.
blocking agent ! (l-norepinephrespect to theit
rffectivenrss in combating experimental hemorrhagic shock. Pervious experiments had indicated that drugs which block the vascular response. to both circulating adrenergic substances and to nerve activity, like Dibenamine, protected animals against the shock resulting from blood volume reduction. The favorable effect of the adrenergic blocking agents may be due to the improved perfusion of tissues, the improved distribution of available blood, and possibly to support of the plasma volume by some effect on the capillary membranes. There is a natural reluctance, however. to use agents which may lower the blood pressure: still further in treatment of severe shock.
.4mong the steroid hormones, hydrocortisone, which demonstrates certain properties of both mineralocorticoids and glucocorticoids, is thtx most effective in restoring the blood pressure in rases of hemorrhagic hypotension. The tentative suggestion was made that hydrocortisone in large doses may possess an adrenergic blocking action, as indicated by the protection offered in shock due to endotoxins and to epinephrine. The present Fxperiments compared the effecta of hydralaxine, hydrocortisone, and I-norepinrphrine reversible rontrols
in preventing hemorrhagic wrrc used in
the shock each
development of irin dogs. Untreated group and showed
a 100 per cent mortality. ,4utopsy findings in the animals which died included. severe necrotic lesions in the bowel. Of the animals receiving hydralazine, 94 per cent of 16 survived. In the hydrocortisonp-treated group, 85 per cent survived. In the I-norepinephrine-treated group, only 23 per cent of 13 survived. Hydralazine (Apresoline) acts as an antihypertensive both centrally on the vasomotor center and peripherally as an adrenergic blocking agent. It may increase renal blood flow and possibly stimulate cardiac action. The drug affords an excellent protection against the irreversibility of shock. Pathologic evidence of decrease in the
Volume Number
84 ti
Selected
severity of bowel lesions may indicate that one area of augmented blood flow was somewhere within the portal bed. The question remains whether the obvious protection of the vital tissues is a result of specific selective improvement in organ perfusion or is secondary to increased venous return to the heart. A drug like dibenzyline may be of value in unmasking oligemia; that is, a fall in blood pressure following administration of the drug means that volume replacement has been inadequate. With hydrocortisone, but not with hydralazine, there is the suggestion of a relative increase in plasma volume. No evidence of an adrenergic block was found with hydrocortisone in the present experiments. The point is stressed that both hydrocortisone and hydralazine are ineffective in treating irreversible shock, but they are important in preventing its development. They must, consequently, be given prior to the development of irreversibility. Norepinephrine offered no significant protection against the development of irreversible shock. Laboratory experiments suggest, on the contrary, that it may render the shocked animal unresponsive to the effects of subsequent transfusion. The present investigators feel that the adrenergic blocking agents have a place as a therapeutic adjunct to blood volume replacement in hemorrhagic shock. The desirable effects may result from a moderation of the intensity of vasoconstriction and a decrease in visceral damage due to anoxia. A shift in emphasis from the sole aim of returning the blood pressure to normal is suggested, with more attention paid to promoting adequate perfusion of tissues. The action of hydrocortisone remains obscure; and norepinephrine in hemorrhagic shock may actually increase peripheral anoxia. The final suggestion is offered that most favorable results may be obtained by appropriate combinations of the three classes of drugs discussed in the paper. Ralph M. Wynn Yo.
4, October,
1961.
*Boles, E. T., Jr., Hardacre, J. M., and Newton, W. A.: Ovarian Tumors and Cysts in Infants and Children, p. 580. Boles, Hardacre, and Newton: Ovarian Tumors and Cysts in Infants and Children, p. 580. Sixteen cases of ovarian tumors in infants and children. representing 10 years’ experience
abstracts
835
at the Columbus Children’s Hospital in Ohio, are reviewed. The ovarian growths are divided into three categories: the first group includes granulosa cell tumors, dysgerminomas, cystadenomas, and embryonal carcinomas, which are improperly classified as ovarian stromal growths; the second group comprises teratomas, the third consists of nonneoplastic cysts. In this series, there were 8 teratomas, 2 malignant tumors (1 embryonal carcinoma and 1 granulosa cell tumor), and 6 nonneoplastic cysts. Ovarian tumors in children present the following signs and symptoms: (1) abdominal mass, (2) abdominal pain, and (3) sexual precocity. The first case report concerns a 5-yearold with a granulosa cell tumor, in whom signs of sexual precocity regressed following unilateral salpingo-oophorectomy. The second case is that of a 15-year-old girl with an embryonal carcinoma, who at laparotomy was found to have generalized metastases and who died one month postoperatively. Although carcinoma of the ovary in children is rare in general, it is more frequently solid than in adults. Whereas less than 3 per cent of all ovarian carcinoma occurs below the age of 20, 10 per cent of all solid ovarian cancer occurs below this age. In this connection, the scarcity of cystadenomas in the child is stressed. Teratomas, the most common ovarian neoplasms of childhood, are usually benign and cystic, although a higher proportion are solid than in the adult. In this series all tumors of this variety were treated by unilateral oophorectomy or salpingo-oophorectomy and all patients did well postoperatively. Of the 6 patients with nonneoplastic cysts, 2 were subjected to laparotomy with the preoperative diagnosis of appendicitis. In one infant, torsion of the pedicle of a large ovarian mass created an acute abdominal condition. Another infant presented with abdominal distention caused by large bilateral corpus luteum cysts. In 2 cases nonneoplastic cysts were associated with sexual precocity. Mention is made of a &year-old who underwent a left salpingooophorectomy for a 5 cm. Graafian follicle ryst. This child had breast development, pubic hair, and a cornified vaginal smear; following operation all these signs regressed. A 2%yearold patient is described who demonstrated polyostotic fibrous dysplasia, flat areas of brownish pigmentation of the skin, and sexual precocity ( McCune-Alhright syndrome=). The pres-