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Studies to determine the cause of hypofibrinogenemia in placental abruption
Southern COMPARISON TAINED
OF
IN
CLINICAL
12-LEAD
SCHMITT’S
Society for Clinical
INFORMATION
CON-
ELECTROCARDIOGRAM
CORRECTED,
ORTHOGONAL
AND LEAD
IN SYS-
Hubert V. Pipberger, * Stanley Bialek, Joseph K. Perlof and Harold W. Schnaper. V. A Hospital, and Dept. of Medicine, Georgetown Univ. Medical Center, Washington, D. C. TEM.
Replacement of the conventional electrocardiogram by corrected, orthogonal systems depends upon ample evidence that all information of clinical significance contained in conventional leads can also be recovered by orthogonal systems. To investigate this, 261 patients with electrocardiographic abnormalities were studied by these two recording technics, using conventional methods of interpretation. Special attention was focused on minor electrocardiographic changes. Only scalar recordings were used. Significant detail encountered in the conventional tracings could definitely not be recognized in the three orthogonal leads in eleven cases. In eight further cases, characteristic features were recognized only in a poorly identifiable form. A further correlation was performed between the conventional tracings and resolved leads (electronically derived from the three basic using directions similar to the conleads), ventional electrode locations. Comparable detail was found in both types of recordings in 260 cases. In one case the reproduction of a T wave abnormality in the resolved leads was questionable. These data suggest that although three-lead orthogonal systems contain all electrical information derived from conventional electrocardiograms, at the present time resolution and/or refined reading technics of these three leads appear necessary in 7 per cent of the cases to yield the clinical information contained in the standard electrocardiogram. STUDIES
TO
DETERMINE
THE
CAUSE
OF
HYPO-
Jack A. Pritchard * and Majorie R. Wright. Department of Obstetrics and Gynecology, Univ. of Texas Southwestern Medical School, Dallas, Texas.
FIBRINOGENEMIA
IN
PLACENTAL
ABRUPTION.
Commonly proposed to explain the development of hypofibrinogenemia following placental abruption are (1) intravascular coagulation due to thromboplastin entering the maternal circulation or (2) intense fibrinolytic activity. ImAUGUST,
1959
Research
321
pressed by the paucity of evidence supporting either concept, studies were initiated to measure the fibrin in the blood clots obtained from the uterine cavity at delivery. These were frozen, thawed, homogenized and centrifuged. The residue was washed repeatedly with saline until colorless, freed of any lipids, and dried. Specimens of blood of which the fibrinogen content was altered widely by adding bovine fibrinogen were clotted with thrombin and similarly treated. The amounts of insoluble protein recovered from the prepared clots were almost identical with the initial fibrinogen content of the specimens. From both the intrauterine and prepared clots the insoluble protein had a tyrosine content similar to that of fibrinogen and was lysed when incubated with bovine fibrinolysin. In five cases of placental abruption with hypofibrinogenemia studied to date the recovered protein equalled two-thirds to threefourths of the fibrinogen calculated to have been lost from the maternal circulation. It is concluded that the major cause of hypofibrinogenemia in placental abruption is coagulation within the uterine cavity. ANTIMETABOLIC EFFECT OF DL-3,3’,5’ TRIIODOTHYRONINE. James A. Pittman, John 0. Tingley, John R. Nickerson, Robert L. Hayes and S. Richardson Hill, Jr.* Dept. of Medicine and Univ. Hospital, Univ. of Alabama Medical Center, and Medical Service, V. A. Hospital, Birmingham, Ala. DL-3,3’,5’ triiodothyronine (“reverse trit”) was given orally to six patients to evaluate it for inhibition of the calorigenic effect of thyroid hormones. In one euthyroid and one hyperthyroid patient there was no change from control values in the basal metabolic rate or serum cholesterol during administration of reverse trit alone in doses up to 0.68 mg./kg. (single dose of 20 mg./day) at the end of ten days. The twentyfour-hour thyroidal I 131uptake in the euthyroid patient diminished from 29.5 per cent to 9.4 per cent. Two hypothyroid patients who were being maintained on desiccated thyroid, 60 and 120 mg. per day, were given reverse trit for four to eight days in doses of 40 to 80 and 80 to 160 mg./day, respectively. The former showed no significant change in basal metabolic rate, but the latter showed a distinct fall from -8 per cent to - 32 per cent with post-treatment rise to 0 per cent in fourteen days. Two patients with
OF
IN
CLINICAL
12-LEAD
SCHMITT’S
Society for Clinical
INFORMATION
CON-
ELECTROCARDIOGRAM
CORRECTED,
ORTHOGONAL
AND LEAD
IN SYS-
Hubert V. Pipberger, * Stanley Bialek, Joseph K. Perlof and Harold W. Schnaper. V. A Hospital, and Dept. of Medicine, Georgetown Univ. Medical Center, Washington, D. C. TEM.
Replacement of the conventional electrocardiogram by corrected, orthogonal systems depends upon ample evidence that all information of clinical significance contained in conventional leads can also be recovered by orthogonal systems. To investigate this, 261 patients with electrocardiographic abnormalities were studied by these two recording technics, using conventional methods of interpretation. Special attention was focused on minor electrocardiographic changes. Only scalar recordings were used. Significant detail encountered in the conventional tracings could definitely not be recognized in the three orthogonal leads in eleven cases. In eight further cases, characteristic features were recognized only in a poorly identifiable form. A further correlation was performed between the conventional tracings and resolved leads (electronically derived from the three basic using directions similar to the conleads), ventional electrode locations. Comparable detail was found in both types of recordings in 260 cases. In one case the reproduction of a T wave abnormality in the resolved leads was questionable. These data suggest that although three-lead orthogonal systems contain all electrical information derived from conventional electrocardiograms, at the present time resolution and/or refined reading technics of these three leads appear necessary in 7 per cent of the cases to yield the clinical information contained in the standard electrocardiogram. STUDIES
TO
DETERMINE
THE
CAUSE
OF
HYPO-
Jack A. Pritchard * and Majorie R. Wright. Department of Obstetrics and Gynecology, Univ. of Texas Southwestern Medical School, Dallas, Texas.
FIBRINOGENEMIA
IN
PLACENTAL
ABRUPTION.
Commonly proposed to explain the development of hypofibrinogenemia following placental abruption are (1) intravascular coagulation due to thromboplastin entering the maternal circulation or (2) intense fibrinolytic activity. ImAUGUST,
1959
Research
321
pressed by the paucity of evidence supporting either concept, studies were initiated to measure the fibrin in the blood clots obtained from the uterine cavity at delivery. These were frozen, thawed, homogenized and centrifuged. The residue was washed repeatedly with saline until colorless, freed of any lipids, and dried. Specimens of blood of which the fibrinogen content was altered widely by adding bovine fibrinogen were clotted with thrombin and similarly treated. The amounts of insoluble protein recovered from the prepared clots were almost identical with the initial fibrinogen content of the specimens. From both the intrauterine and prepared clots the insoluble protein had a tyrosine content similar to that of fibrinogen and was lysed when incubated with bovine fibrinolysin. In five cases of placental abruption with hypofibrinogenemia studied to date the recovered protein equalled two-thirds to threefourths of the fibrinogen calculated to have been lost from the maternal circulation. It is concluded that the major cause of hypofibrinogenemia in placental abruption is coagulation within the uterine cavity. ANTIMETABOLIC EFFECT OF DL-3,3’,5’ TRIIODOTHYRONINE. James A. Pittman, John 0. Tingley, John R. Nickerson, Robert L. Hayes and S. Richardson Hill, Jr.* Dept. of Medicine and Univ. Hospital, Univ. of Alabama Medical Center, and Medical Service, V. A. Hospital, Birmingham, Ala. DL-3,3’,5’ triiodothyronine (“reverse trit”) was given orally to six patients to evaluate it for inhibition of the calorigenic effect of thyroid hormones. In one euthyroid and one hyperthyroid patient there was no change from control values in the basal metabolic rate or serum cholesterol during administration of reverse trit alone in doses up to 0.68 mg./kg. (single dose of 20 mg./day) at the end of ten days. The twentyfour-hour thyroidal I 131uptake in the euthyroid patient diminished from 29.5 per cent to 9.4 per cent. Two hypothyroid patients who were being maintained on desiccated thyroid, 60 and 120 mg. per day, were given reverse trit for four to eight days in doses of 40 to 80 and 80 to 160 mg./day, respectively. The former showed no significant change in basal metabolic rate, but the latter showed a distinct fall from -8 per cent to - 32 per cent with post-treatment rise to 0 per cent in fourteen days. Two patients with