Charles E. Flowers

The effects of suppression of menstruation with ethynodiol diacetate upon the pituitary, ovary, and endometrium

Abstract 1. 1. Following 26 months of semicontinuous therapy with ethynodiol diacetate, pituitary function was studied by daily assays of FSH and LH; ovarian function was studied by daily determinations of E1, E2, and E3 and periodic measurements of pregnanediol. The endometrium was studied with hematoxylin and eosin and histochemical preparations. 2. 2. Ovulation occurred in the 4 study patients during the first cycle off medication. There was complete recovery of the pituitary, ovary, and endometrium within 3 months following the discontinuance of the progestin. 3. 3. The order of complete recovery was (1) pituitary; (2) ovary; (3) endometrium. 4. 4. Semicontinuous therapy with ethynodiol diacetate was successful in managing various menstrual dysfunctions by prolonging the intervals between menstrual periods and decreasing the amount of menstrual flow. This progestin proved to be a convenient oral contraceptive.

Spontaneous premature rupture of the membranes.

Abstract A sample of cases of spontaneous premature rupture of the membranes associated with the delivery of approximately 7,500 infants weighing 400 grams and above is presented. The over-all incidence of premature rupture of the membranes was 15.8 per cent. The incidence of premature rupture of the membranes among the fetal and neonatal deaths was 26.7 per cent. Premature rupture of the membranes occurred in association with a sizable number of major obstetrical complications. Infection was the principal lethal factor in the infant deaths which were primarily due to premature rupture. It occurred more frequently among the non-white and less educated mothers, and was tolerated less well by the older mothers from lower socioeconomic groups, whether the classification was based upon the mothers education, race, or the fathers occupation. Premature rupture of the membranes is a major obstetrical complication which requires additional study.

Trilene, an adjunct to obstetrical anesthesia and analgesia

Abstract Trilene is a potent analgesic drug. Its margin of safety and ease of administration will ultimately make it a standard agent on all delivery floors. Trilenes wide variety of uses will probably allow almost every obstetrician to find a place for it in his obstetrical practice.

Germ-free delivery. The initiation of management of infants with a high probability of congenital immune deficiency states

Abstract Germ-free delivery of an infant with a high probability of congenital severe combined immune deficiency disease was accomplished by cesarean section without major modification of routine medical and nursing procedures. The male sex of the infant had been determined by karyotype on amniotic fluid cells, thus the risk of being affected by an X-linked disease was established. Intensification of ordinary methods for preparation of operating area and personnel resulted in successful germ-free delivery. Highly technical equipment and specially trained people with attendant high cost were not required. The infant was placed in a sterile plastic flexible film isolator where he has been maintained in a gnotobiotic state for twelve months (to date) free of infection in spite of continued immune incompetence. With the likelihood that lesser forms of this disease may be more common than heretofore expected and with the advent of new obstetric and immunologic diagnostic techniques, sterile delivery may assume more importance in the future.

A prospective comparison of two endogenous creatinine clearance testing methods in hospitalized hypertensive gravid women

OBJECTIVE Although 24-hour endogenous creatinine clearance testing is common in pregnancies complicated by hypertension, inaccuracies limit its usefulness. We controlled the conditions under which 4-hour endogenous creatinine clearance testing was performed and compared the results with outcomes of 24-hour tests from the same patients. STUDY DESIGN In 83 women hospitalized with mild hypertension in the third trimester, we measured endogenous creatinine clearance with a 4-hour urine collection during lateral recumbency and supervised oral hydration. This test was paired with a 24-hour test performed immediately thereafter. No restrictions or recommendations regarding ambulation or oral intake were imposed for the 24-hour test. RESULTS The 4-hour endogenous creatinine clearance value exceeded the 24-hour value in 133 of the 136 paired comparisons (p < 0.0001). Results of the tests from only the 29 patients with multiple paired tests showed more similarity (p < 0.005) among the 4-hour than among the 24-hour clearances. CONCLUSION The 4-hour endogenous creatinine clearance test, as described, provides a higher and less variable estimate of renal function in hypertensive pregnant women than does the 24-hour test.

A carbonic anhydrase inhibitor as a diuretic in obstetrics

Abstract Our inadequate knowledge concerning the etiology of toxemia of pregnancy has led us to treat this clinical entity empirically. Eclamptic convulsions are managed by sedation or parenteral magnesium sulfate. Hypertension is treated by sedation and hypotensive drugs. Fluid retention is controlled by the restriction of sodium and water as well as by the use of diuretics. The definitive treatment of toxemia of pregnancy, however, is delivery of the infant. This study was made in an effort to determine the usefulness of the diuretic, Diamox, 2-acetylamino 1,3,4-thiadiazole-5-sulfonamide (acetazoleamide), a carbonic anhydrase inhibitor, in controlling fluid retention in pregnancy.