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Transfusion death of a woman recently delivered of a hydrops fetus and placenta. The clinical significance of the Rh factor
SELECTED
ABSTRACTS
713
Castle, does not apply to the cases herein reported. Further, these cases failed to show many of the clinical and laboratory criteria necessary for the diagnosis of true Addisonian anemia. In this communication the authors suggest that there may be another factor present in the various liver extracts and in autolized yeast. They initiate the term “Wills’ factor” for this, as yet, hypothetical substance. Four cases, two of which occurred during pregnancy, are reported that failed to respond to different types of liver extract administered parenterally in the usual doses. Three of the cases showed an immediate and striking response to two types of liver extract when given by mouth. The fourth case responded very well when the dose of the parenteral liver extract was increased tenfold. In one case, in order to prove that Wills’ factor was not identical to any of the several pure components of the vitamin B complex or with ( r Folic Acid, ” they were administered in large doses without producing any response. It is of importance to the obstetrician to remember that a rare ease of nutritional macroeytic anemia in pregnancy which fails to respond to the purified liver extracts may react to relatively crude oral liver extracts. Finally the authors emphasize the demonstrated therapeutic values of the parenterally administered refined liver extract in the vast majority of cases of nutritional macrocytic anemia, HERBERT J. SIBION.
Thomas, Rufus C.: & Gynaec.
Brit.
Rupture Emp.
of the Rectus Abdominis
Muscle During
Pregnancy,
J. Obst.
52: 580, 1945.
The author has previously reported a ease of rupture of the rectus abbdominis muscle during pregnancy, and reports a second ease in this article. In this case the patient had had five previous normal pregnancies and deliveries and one abortion. She was admitted to the hospital when about thirty-three weeks pregnant, with a history of bronchitis and pain in the had also been noticed in the region of the right abdomen when she coughed; a “lump” rectus muscle. While a diagnosis of concealed accidental hemorrhage was made, the uterus was softer than it would be with such a hemorrhage, that produced abdominal tenderness. While under observation she developed typical symptoms of internal hemorrhage, and operation was done. This showed a tear in the right rectus muscle with bleeding from a branch of the deep epigastric artery and another smaller vessel; blood clots were removed, the bleeding arteries ligatured, and a pack placed along the. deep surface of the rectus muscle, and brought out through the lower end of the incision, which was then closed. On the fifth day after operation, the patient was delivered of a stillborn child. The patient finally made a good recovery, which was delayed by a reaction to an incompatible blood transfusion. A review of the literature shows this to be the thirty-second case reported of rupture of the rectus muscle during pregnancy; the correct diagnosis was made before operation in only nine of the 32 cases. Cullen’s sign was present in five of the cases, including the case reported. The maternal mortality was 13 per cent, the fetal mortality about 50 per cent. Conservative treatment is justified in these cases only if the patient’s condition remains good; if signs of increasing hemorrhage and shock develop operation is indicated. HARVEY B. MATTHEWS.
Wespi, H. J.: Placenta.
Transfusion Death of a Woman Recently Delivered of a Hydrops Fetus and The Clinical Signticance of the Rh Factor, Gynaecologia 121: 47-57, 1946.
The author gives a description of a fatal case due to transfusion in a para vi patient on whom embryotomy had to be performed because of obstruction in labor caused by hydrops Ten minutes after transfusion of 400 C.C. of eitrated blood of the fetus and placenta. of the same group cyanosis and dyspnea, and four hours later death occurred. The previous history was important; after two normal deliveries, there was icterus gravis of the third child and stillbirths in the fourth and fifth pregnancies, therefore the typical picture of hereditary erythroblastosis. The author discusses recent investigations of the Rhesus factors and their The present case importance for the origin of erythroblastosis and accidents in transfusion. The author also takes corresponds in a classical way with the results of these investigations. especially by avoiding transfusions up the matter of prevention of accidents in transfusion, J. P. GREENHILL. in women who had given birth to dead children.
ABSTRACTS
713
Castle, does not apply to the cases herein reported. Further, these cases failed to show many of the clinical and laboratory criteria necessary for the diagnosis of true Addisonian anemia. In this communication the authors suggest that there may be another factor present in the various liver extracts and in autolized yeast. They initiate the term “Wills’ factor” for this, as yet, hypothetical substance. Four cases, two of which occurred during pregnancy, are reported that failed to respond to different types of liver extract administered parenterally in the usual doses. Three of the cases showed an immediate and striking response to two types of liver extract when given by mouth. The fourth case responded very well when the dose of the parenteral liver extract was increased tenfold. In one case, in order to prove that Wills’ factor was not identical to any of the several pure components of the vitamin B complex or with ( r Folic Acid, ” they were administered in large doses without producing any response. It is of importance to the obstetrician to remember that a rare ease of nutritional macroeytic anemia in pregnancy which fails to respond to the purified liver extracts may react to relatively crude oral liver extracts. Finally the authors emphasize the demonstrated therapeutic values of the parenterally administered refined liver extract in the vast majority of cases of nutritional macrocytic anemia, HERBERT J. SIBION.
Thomas, Rufus C.: & Gynaec.
Brit.
Rupture Emp.
of the Rectus Abdominis
Muscle During
Pregnancy,
J. Obst.
52: 580, 1945.
The author has previously reported a ease of rupture of the rectus abbdominis muscle during pregnancy, and reports a second ease in this article. In this case the patient had had five previous normal pregnancies and deliveries and one abortion. She was admitted to the hospital when about thirty-three weeks pregnant, with a history of bronchitis and pain in the had also been noticed in the region of the right abdomen when she coughed; a “lump” rectus muscle. While a diagnosis of concealed accidental hemorrhage was made, the uterus was softer than it would be with such a hemorrhage, that produced abdominal tenderness. While under observation she developed typical symptoms of internal hemorrhage, and operation was done. This showed a tear in the right rectus muscle with bleeding from a branch of the deep epigastric artery and another smaller vessel; blood clots were removed, the bleeding arteries ligatured, and a pack placed along the. deep surface of the rectus muscle, and brought out through the lower end of the incision, which was then closed. On the fifth day after operation, the patient was delivered of a stillborn child. The patient finally made a good recovery, which was delayed by a reaction to an incompatible blood transfusion. A review of the literature shows this to be the thirty-second case reported of rupture of the rectus muscle during pregnancy; the correct diagnosis was made before operation in only nine of the 32 cases. Cullen’s sign was present in five of the cases, including the case reported. The maternal mortality was 13 per cent, the fetal mortality about 50 per cent. Conservative treatment is justified in these cases only if the patient’s condition remains good; if signs of increasing hemorrhage and shock develop operation is indicated. HARVEY B. MATTHEWS.
Wespi, H. J.: Placenta.
Transfusion Death of a Woman Recently Delivered of a Hydrops Fetus and The Clinical Signticance of the Rh Factor, Gynaecologia 121: 47-57, 1946.
The author gives a description of a fatal case due to transfusion in a para vi patient on whom embryotomy had to be performed because of obstruction in labor caused by hydrops Ten minutes after transfusion of 400 C.C. of eitrated blood of the fetus and placenta. of the same group cyanosis and dyspnea, and four hours later death occurred. The previous history was important; after two normal deliveries, there was icterus gravis of the third child and stillbirths in the fourth and fifth pregnancies, therefore the typical picture of hereditary erythroblastosis. The author discusses recent investigations of the Rhesus factors and their The present case importance for the origin of erythroblastosis and accidents in transfusion. The author also takes corresponds in a classical way with the results of these investigations. especially by avoiding transfusions up the matter of prevention of accidents in transfusion, J. P. GREENHILL. in women who had given birth to dead children.