Curtis J. Lund

Blood volume during pregnancy. Significance of plasma and red cell volumes.

Abstract During the past 15 years, plasma and red cell volumes have been studied in 85 normal healthy women in the reproductive age and in 375 normal healthy pregnant women. The data have been recorded by weight (ml./Kg.) and by total volume (ml.). Variation between individuals is great but in the same individual it is small.

The blood volume of infants

Summary The subjects of this study were 126normal full-term infants on whom 223 plasma volume determinations were made using a T-1824 dye dilution technique. Of these infants, 2 observations were made on 47, and 3 or more serial observations were made on 20. Total blood and erythrocyte volumesand total circulating hemoglobin mass values were calculated from the plasma volume, venous hematocrit, and hemoglobin concentration. No reliable average blood volume could be observed in either the neonatal period or during the succeeding 11 months of life, owing to a wide range of values throughout the year. The average erythrocyte volume, circulating hemoglobin mass, and total hemoglobin iron values did not return to neonatal levels until 16 weeks after birth. Assessment of anemia in the infant from blood loss, iron deficiency, or other causes can be aided by the determination of the erythrocyte volume and hemoglobin mass. We believe that more reliance can be placed on these values than on those of the hemoglobin concentration and hematocrit because of the considerable number of infants who demonstrate hypo- or hypervolemia. In these states paradoxical values of hemoglobin concentration and hematocrit are frequently encountered which yield misleading information.

Carcinoma of the corpus uteri: a 10-year review of 225 patients.

Data on 225 patients with endometrial adenocarcinoma or adenoacanthoma treated at the Strong Memorial Hospital Rochester New York during the 10-year period beginning January 1957 are compared with an earlier report of 339 patients having a similar diagnosis during the previous 30-year period. Of 16211 patients admitted to the gynecologic service during the 1957-1967 period 784 (4.8%) were found to have malignancies of the genital tract. The 225 patients with endometrial carcinoma represented 28.7% of gynecologic malignancies and 1% of all gynecologic admissions. This incidence was unchanged from that of the earlier series. Only 1 patient was lost to follow-up. 153 patients (77%) had an early stage of the disease 27 (14%) were Stage 2 13 (7%) had Stage 3 and 4 (2%) were classified as Stage 4. 55% of the patients were over age 60 while 14.5% were premenopausal. Abnormal or postmenopausal bleeding had prompted medical consultation in 7.8% of whom 74% reported symptoms of less than 6 months duration. 12% were diabetic and 20% weighed more than 80 kg 15 patients weighing more than 100 Kg. Available reports of cytologic smears were positive in only 25%. Estrogen therapy was not found related to the tumors. 6 patients had had previous oophorectomy. 7.5% had received previous pelvic irradiation. In 8% there were primary malignancies in other organs. 14% had never been married. Of those married 28% were nulliparous. Treatment was surgical with or without radiation therapy. The overall corrected 5-year survival rate was 69%. Of 106 who had not yet reached 5 years since operation 49 died of the disease and 49 patients were alive and without evidence of the disease. Isolated vaginal recurrences were rare. Survival was affected by age at diagnosis stage of disease depth of myometrial invasion and cellular differentiation of the tumors. The younger women fared better than those over age 60 at the time of diagnosis. 37 developed some form of recurrent disease 25 of these within the first 2 years and 4 after 5 years. Of these 2 had recurrences after more than 10 years. 24 of these 37 patients died of the recurrent disease within 1 year of its recognition. 2 of 11 patients with recurrences who received progestational agents and 4 of 12 who received radiation therapy survived 5 years. The survival of patients with adenocarcinoma and those with adenoacanthoma was the same. It is stated that the uterus should be removed when a bilateral oophorectomy is performed. Uterine radiation should not be used for treatment of benign bleeding problems. Cytological cervical and vaginal smears are not sufficient to rule out endometrial carcinoma. Fractional curettage is needed with early diagnosis and quick definitive therapy.

Cinefluorographic Studies of the Bladder and Urethra in Women

Abstract Cinefluorography has been adapted to the study of the bladder and urethra in women. From 500 to 2,000 frames can be made for each patient. Projection of these motion pictures provides a new technique for the study of normal and abnormal urination. Further study will be necessary before the method can be applied clinically.

Antepartum pulmonary embolism

Abstract Antepartal thromboembolic disease appears to be increasing during the prenatal period and decreasing in the puerperium. Antepartal pulmonary thromboembolism, although rare, may be commoner than expected and in our series of 20 cases half of them appear in the first trimester. Once a firm diagnosis is made, which is usually possible, the patient is treated with anticoagulants. Intravenous heparin is used for the first 7 to 10 days followed by sodium warfarin until term, at which time it is stopped and heparin is again started and maintained through delivery and the early puerperium. Maternal complications of anticoagulant therapy have not been a problem. One fetus died in utero and was macerated at delivery without evidence of hemorrhage. Others have described this phenomenon. Four patients had adjunctive operations—femoral thrombectomy, vena caval ligation, and pulmonary thrombectomy when anticoagulants failed to control the disease. There were 2 maternal deaths. One death followed complete anticoagulation therapy and pulmonary arterial thrombectomy, the other patient died before treatment could be instituted.

Emergency cesarean section

Emergency cesarean section is indicated when complications acutely threaten the life of the mother and/or fetus. The indications are almost exclusively fetal distress, antepartum hemorrhage, or both. To be most effective, delivery should be accomplished with in 15 minutes after the decision to operate is made. Moderate and large obstetric services should be required to be capable of performing a real emergency cesarean section.

Incidence of trophoblastic disease: Increased rate in youngest age group

The incidence of trophoblastic disease at Strong Memorial Hospital between 1957 and 1968 is 5.8 cases per 10,000 pregnancies terminated. The incidence has increased significantly over this period, with the highest rate observed among the teen-age women, as well as among those over 35 years of age. Problems in the calculation of trophoblastic disease rates are discussed and suggestions made for future studies.

Cinefluorographic Studies of the Bladder and Urethra in Women: II. Stress Incontinence

Abstract Cinefluorography has been adapted to the study of the bladder and urethra in women. From 500 to 2,000 frames can be made for each patient. Projection of these motion pictures provides a new technique for the study of normal and abnormal urination. Further study will be necessary before the method can be applied clinically.

Absorption of transfused chromium-labeled erythrocytes from the fetal peritoneal cavity in hydrops fetalis

Abstract It would be indicated from these studies that a hydropic fetus with ascites can and does absorb transfused red blood cells rapidly from the peritoneal cavity and that the ascitic fluid per se does not prevent this absorption.

Effect of lactation on blood volume in the human female

T H E P u a P 0 s E of this paper is to present data regarding the effect of lactation on blood volume in the human female. The literature on blood volume changes during pregnancy is voluminous but largely descriptive. Etiologic factors remain unclear. Therefore, it is somewhat surprising to note the paucity of studies designed specifically to determine the relationship between lactation and blood volume. The review of the literature back to 1940 has failed to reveal any such study in the human female. Turner and Herman1 report a definite increase in total blood volume during lactation in dairy cattle. In the same subject, Reynolds2 found lactation to be associated with an increase in plasma volume to magnitudes of 25 per cent with the maintenance of normal hematocrits. Hansard and associates3 report an increased total blood volume with normal hematocrits in lactating burros. Bond4 has reported an increased red cell and plasma volume in lactating rats as compared to nonpregnant controls. He found that the hypervolemia returned to normal when lactation ceased. Bond also comments on the paucity of studies in this area and speculates upon an endocrine etiology for the findings described. Fifty-nine subjects were studied. Twenty-one women breast-fed their babies throughout the period of the study and are referred to as the study group. The control group consisted of 38 women who bottle-fed their babies throughout