John C. Morrison

Mumps Oophoritis: A Cause of Premature Menopause *

One cause of secondary oligomenorrhea is ovarian infection. A rare type of infection related to the disturbance of menstrual function is mumps oophoritis. Three patients with premature menopause presumably caused by this agent were described. In one patient the symptoms coincided with a subclinical infection during the perinatal period, with subsequent infertility. Another patient seemed to have had a clinically mild oophoritis during the pubertal period, and the third patient became symptomatic following parturition. It appears that this aberration in menstrual function and fertility may be related to the time during which the infection occurs as well as to the severity of the infection. In addition, it is apparent that mumps oophoritis may be a more frequent cause of premature menopause than has heen previously suspected.

The use of medroxyprogesterone acetate for relief of climacteric symtoms

Climacteric symptoms in the menopausal woman are perplexing to the physician. Recent literature concerning the relationship of estrogen to carcinogenesis has caused many women to discontinue this medication; thus, there is a need for an alternative therapy for the relief of these symptoms. The drug medroxyprogesterone acetate (Depo-Provera) was assessed in a double-blind, randomized, placebo-controlled study involving 48 subjects. Only one of the placebo-treated patients claimed any relief from climacteric symptoms while only two of the patients who received the study drug noted little or no relief (P < 0.0001). Relief from climacteric symptoms began at 4 to 7 days after entry into the study and extended for 8 to 20 weeks. The only side effects were withdrawal bleeding and a slight, transient weight gain. Depo-Provera appears to be a reliable substitute for estrogen in the treatment of climacteric symptoms. Further investigations with this medication seem indicated.

Metabolites of meperidine related to fetal depression.

Abstract Three specific patterns of meperidine metabolism were observed in the maternal serum of 52 patients studied. These patterns appear to be related to the rate of formation of certain metabolites of the compound. No observable signs of infant depression were detectable when delivery was performed during the first 60 minutes following the administration of the analgesic agent regardless of the type of pattern. However, when greater than 60 minutes had elapsed following intravenous injection of meperidine the incidence of depressed infants was directly related to the more rapid metabolic patterns. Therefore, the most significant factors relating infant depression to meperidine are the maternal metabolic pattern and the length of time the patient is in labor following the administration of the compound. These observations presumably reflect the increased toxicity of certain metabolites of meperidine transferred to the fetus from the mother. Thus, if delivery takes place within 60 minutes after injection, the level of metabolites of meperidine in the fetus should be low and the chance of a depressed infant reduced.

Counseling the patient with sickle cell disease about reproduction: Pregnancy outcome does not justify the maternal risk!

A retrospective study of 35 HbSS and 15 HbSC pregnant patients was undertaken to illustrate the hazards to both mother and child of gestations associated with these hemoglobinopathies. It was found that these patients experienced a 10% to 14% maternal mortality rate and a 51% to 55% perinatal mortality rate. The fact that the mother, due to her illness, cannot care for the child, coupled with the poor medical health that the offspring themselves have if they too inherit the homozygous gene, provides additional support to the concept that some form of relief should be offered these women. Based on the figures of this study and those of others, aggressive genetic counseling to the women is advocated including liberal surgical sterilization and primary abortion in certain cases.

The lecithin/sphingomyelin ratio in cases associated with fetomaternal disease

The efficacy of correlating the L/S ratio in the amniotic fluid with fetal lung maturity has been substantiated in normal pregnancies. In gestations complicated by fetomaternal diseases, however, the assay is less reliable. This study involves 555 pregnancies in which there was a significant maternal, fetal, or placental disorder. The L/S ratio was related to fetal respiratory maturity as measured by Dubowitz criteria and the occurrence of RDS. The results show that pre-eclampsia, chronic hypertension, diabetes (Class D, E, F), significant cardiovascular disease, severe hemoglobinopathies, various congenital anomalies, chronic placental insufficiency, and prolonged ruptured membranes accelerated the L/S ration. Conversely, mild diabetes (Class B, C), intrinsic renal disease, hepatitis, collagen disease, hydrops fetalis, syphilis, and toxoplasmosis were associated with a delay in the L/S ratio. A significant increase in erroneous responses was noted in these patients when the L/S ratio was correlated to infant maturity and to the incidence of RDS. Possible mechanisms for these findings are discussed.

Metabolites of meperidine in the fetal and maternal serum

Although meperidine appears to be the safest obstetric analgesic agent, it has been associated with infant respiratory depression in certain situations. It would appear that the incidence of fetal depression related to meperidine is dependent on the time of injection prior to delivery, the quantity of drug administered, and the rate of maternal metabolism of the analgesic. Previous work showed that meperidine is metabolized in the maternal system by one of three patterns. The present study demonstrates that the particular maternal serum pattern is characteristic for the individual, regardless of whether the patient is pregnant or not, and that the fetal depression, although usually mild, can be correlated with fetal pH data as well as Apgar scores. In addition, this study supports indirectly the contention that metabolites of meperidine rather than the parent compound cause fetal depression. It would appear, therefore, that in certain obstetric cases with a higher probability for infant depression, other analgesic agents might be considered, especially if the serum pattern indicates meperidine is being metabolized.

Use of partial exchange transfusion preoperatively in patients with sickle cell hemoglobinopathies

Sickle cell anemia and other severe sickle cell disorders (hemoglobin SC and hemoglobin S-thalassemia) are known to complicate surgical procedures in susceptible patients. Although transfusions have been used preoperatively to increase the packed cell volume, we have recently used the method of partial exchange transfusion in the treatment of patients with these disorders in the preoperative period. Forty-two patients with significant sickle cell hemoglobinopathies underwent operative procedures on various surgical services. The goal was to obtain a hemoglobin A percentage of 40 or above in each case, and this required 480 to 1,150 c.c. of buffy coat poor washed red cells (mean 820 c.c.). The number of complications in the intraoperative and postoperative period in this study was compared to those found in the literature. There was a significant decrease in morbidity and mortality rates noted with the use of these transfusions. There appeared to be a great advantage on a cost-benefit ratio, as well as an improvement in the physiologic state of the patient. Although the results of this study show significant improvement over previous investigations, there are many facets unknown concerning the use of this modality under these and other conditions. Therefore, further investigation of this method and restriction of the method of Level III referral centers is advocated until enough patients have been studied to assess the long- and short-term complications of the procedure.

The effect of maternal partial exchange transfusion on the infants of patients with sickle cell anemia

The reproductive outcome of pregnancies complicated by severe sickle cell hemoglobinopathies is not usually satisfactory. In this study, prophylactic partial exchange transfusions have been used in 35 patients with sickle hemoglobinopathies. There was significant improvement in results, both maternal and neonatal, as compared to those in 29 pregnancies complicated by similar disease processes who did not receive this therapy. The former group was also compared to 61 normal pregnant patients and 31 patients with sickle cell trait, none of whom received blood as part of their therapy. The results were similar in the group receiving transfusions and in the group with sickle cell trait. There was a decrease in perinatal wastage, prematurity, and incidence of low-birth-weight infants in the transfusion group when compared to the patients with hemoglobinopathies who were treated conservatively.

Cerebral spinal fluid studies in eclampsia

Abstract During the 5 year period 1966–1970, 94 eclamptic patients were delivered of infants at the City of Memphis Hospitals. The cerebrospinal fluid of the last 21 patients was studied in an attempt to clarify the various neurological manifestations of this syndrome. The results were compared with cerebral spinal fluid obtained at delivery from 25 patients with severe pre-eclampsia, 10 with chronic hypertensive vascular disease, 9 with documented seizure disorders, and 35 patients with normal term pregnancies. Nineteen of the 21 eclamptic patients had bloody spinal fluid (hematorrhachis), and this finding, in addition to others, is correlated with neurological deficits and prognosis.

Placental transfer of intravenous fluoride in the pregnant ewe

Fluoride ion is produced with the biotransformation of two commonly used anesthetics, methoxyflurane and enflurane. Fluoride ion is added to prenatal vitamin preparations and water to prevent carious teeth. Very high levels of fluoride assailure. Previous studies of placental transfer of fluoride ion were conflicting. Our study in pregnant ewes revealed rapid transfer of the fluoride ion across the placenta with high fetal to maternal ratios as early as 1 minute.