John C. Ullery

Observations on the Mechanism of Action of Clomiphene (MRL-41)

Serial follicle stimulaint hormone (FSH) and luteinizing hormone (LH) determinations (by the methods of Steelman and Pohley and Parlow respectively) in 4 23-53 year old anovulatory patients given short-term clomiphene treatment (100-400 mg orally/day for 6 days) were employed in studying the mechanism of clomiphene action. Serial determinations of 3 estrogens (estrone estradiol and estriol) were also determined using thin-layer absorption chromatography before Kober color development. FSH levels rose in all cases during or immediately following clomiphene therapy. LH did not rise prior to a rise in estrogens. The estradiol fraction was found to contain at least 3 different components. During clomiphene therapy the estradiol fraction fell. Since the estradiol fraction was composed of 2 compounds in addition to estradiol and since it fell during treatment it was postulated that it was the unidentified estrogens whose excretion had decreased. It was suggested that this fall in unidentified estrogens may be responsible for the increase in FSH release observed during treatment.

The management of pregnancy complicated by heart disease

Abstract In a review of the histories of 41,361 women delivered at the Pennsylvania Hospital during the years 1937 to 1952, inclusive, the total number with heart disease was found to be 565, an incidence of 1.12 per cent. The maternal mortality rate in the pregnant cardiac patient was 2.6 per cent (15 maternal deaths). The fetal mortality rate was 12.3 per cent (70 fetal deaths). Heart disease has occupied the most prominent position as a cause of maternity mortality, accounting for 27.2 per cent of the maternal deaths from all causes during the sixteen years reviewed in our hospital. Acute congestive failure was the cause of death in 11 of the 15 deaths. Infection was the precipitating factor in 7 cases. Prematurity was the leading cause of death in the babies. The pregnant cardiac patients were divided into two groups: those delivered from 1937 to 1947, and those delivered from 1948 to 1952. The purpose was to analyze the groups in relation to the establishment of the Cardiac-Obstetric Clinic in 1948. Only one maternal death from heart disease has occurred since its inception, that of an unregistered patient. From the analysis of our patients, we believe the problems of management of pregnancy with heart disease should include the following: 1. 1. An understanding of the physiological changes in the circulation in the normal pregnant woman and the changes in the pregnant woman with heart disease 2. 2. The diagnosis and assessment of the pregnant woman with heart disease 3. 3. Proper and adequate treatment during pregnancy, delivery, and pucrperium The different phases of treatment are diseussed in detail. Certain techniques in treatment, such as the increased use of forceps for delivery, conduction block anesthesia, and use of digitalis therapy are emphasized. Close cooperation between the cardiologist and the obstetrician at all times is strongly advocated.

A review of some aspects of the metabolism of progestational agents

Abstract The metabolism of progestational agents is little understood. Much remains to be done in this area, and in view of the fact that increasingly larger numbers of persons are using these drugs for long periods of time, their metabolic fate is important. Recent studies have demonstrated the identification of a new pathway for the metabolism of the 19-Norsteroids, that of a 3β,10β-diol urinary metabolite. Also, tentative data are reported for the peripheral introduction of 17α- and 21-hydroxyl groups into in vivo administered progestational agents.

Dynamic investigation of perinatal mortality

Abstract A study of the problem of perinatal mortality has been undertaken on a clinical level at The Ohio State University Health Center in Columbus, Ohio. The pilot study for the calendar year 1956 is herewith reported and analyzed. Twenty per cent of the cases were found to have some significant factors in management which might have altered the outcome as to perinatal death. The format of study here used has been highly successful and is worthy, in our opinion, of continued use and expansion. The voluntary nature of the study is worth of emphasis. The month-by-month analysis of cases by the staff concerned has been found to be far more rewarding than analysis by a central committee based on detailed questionnaire reporting.

Continuous spinal analgesia in cesarean section

From the experience of delivering three hundred patients by cesarean section under continuous spinal analgesia with no maternal deaths, we feel that it is a safe anesthetic for both mother and child. All of the babies (excepting the stillborn) showed no anoxemia, cried at once, were a good color, and required no resuscitation. The postoperative morbidity of the mother was low, and the complications were no greater than with inhalation anesthetics. The advantages of continuous spinal analgesia with its safety, low dosage, and controllability are emphasized and should make its use desirable in cesarean section. The technique is easy and requires only the care and caution that should be given when administering any anesthetic.Abstract From the experience of delivering three hundred patients by cesarean section under continuous spinal analgesia with no maternal deaths, we feel that it is a safe anesthetic for both mother and child. All of the babies (excepting the stillborn) showed no anoxemia, cried at once, were a good color, and required no resuscitation. The postoperative morbidity of the mother was low, and the complications were no greater than with inhalation anesthetics. The advantages of continuous spinal analgesia with its safety, low dosage, and controllability are emphasized and should make its use desirable in cesarean section. The technique is easy and requires only the care and caution that should be given when administering any anesthetic.