Robert Landesman

The use of a radioreceptorassay of human chorionic gonadotropin for the diagnosis and management of ectopic pregnancy.

The radioreceptorassay of human chorionic gonadotropin (hCG), with a sensitivity of 50 pg or 3 mIU/ml of plasma, has provided almost 100% reliability in detecting pregnancy after the first missed cycle. This test may be performed within 1 hour and is ideally suited to the clinical detection of ectopic pregnancy, especially in patients who require immediate surgical intervention. Thirteen patients with suspected ectopic pregnancy were evaluated by the radioreceptorassay, one of whom was followed with four separate determinations. The results of the assay were subsequently compared with those of hemagglutination pregnancy tests, clinical symptoms, and pathologic findings. All of the patients were diagnosed accurately by the radioreceptorassay, even when hemagglutination tests yielded a false indication of pregnancy. By this assay, the hCG levels during ectopic pregnancies are generally lower than those found during a normal intrauterine pregnancy; in addition, pregnancy may be detected much earlier (prior to the rupture) than is possible by hemagglutination tests. Furthermore, the diagnosis of ectopic pregnancy may be excluded for patients admitted to the hospital with acute abdominal emergencies.

Application of a Radioreceptorassay of Human Chorionic Gonadotropin in the Diagnosis of Early Abortion

A radioreceptorassay for human chorionic gonadotropin (hCG) was used to detect pregnancy as early as 6 to 8 days following conception and to predict spontaneous abortion as early as 8 to 10 days after conception in subjects whose hCG levels were lower than those occurring during normal pregnancy of the same duration. The evidence for the specific measurement of hCG was further provided by the correlation of plasma hCG levels measured by radioimmunoassay using antisera specific for hCG-beta and radioreceptorassay of hCG. By virtue of its sensitivity and specificity, the radioreceptorassay of hCG allowed early and accurate prediction of spontaneous abortion in 15 patients.

The relaxant action of ritodrine, a sympathomimetic amine, on the uterus during term labor

Abstract Ritodrine (Du-21220) administered intravenously at rates from 100 to 200 μg per minute effectively inhibited uterine activity in 12 patients in normal labor at term. Uterine inhibition was associated with minimal cardiovascular effects, primarily a dose-related tachycardia. The effect of ritodrine, its clinical application, and its use in combination with beta-adrenergic-blocking agents are discussed.

Inhibitory action of a new sympathomimetic amine (DU-21220) on the nongravid uterus

Abstract The effects of DU-21220, a new epinephrine derivative, on uterine activity and the cardiovascular system of 40 nonpregnant women was investigated. DU-21220, whether administered orally or by intravenous infusion, was found to be a potent myometrial inhibitor. The only consistent cardiovascular effect was a dose related rise in heart rate.

The effect of ethyl alcohol on isolated human myometrium

Ethyl alcohol inhibits uterine activity in pregnant and nonpregnant women. Studies of the effect of ethanol on pregnant and nonpregnant human myometrium in vitro reveal that concentrations equivalent to the blood concentrations which are effective in vivo are without any significant effect on the spontaneous activity of isolated strips, but that higher concentrations reduce the activity.

Retinal changes in the toxemias of pregnancy. I. History, vomiting of pregnancy, mild and severe pre-eclampsia, and eclampsia.

Abstract The etiological factors responsible for the toxemias of pregnancy have not been revealed despite extensive researches during the past century. Most workers in this problem agree that the maternal vascular bed is extensively involved in this condition. Because of these changes, either gradual or sudden, in the arteriolar system, many of the symptoms and findings of toxemia make their appearance. The vessels may be readily observed by direct visualization of the fundi oculi. Since the New York Lying-In Hospital opened at its present location in 1932, a careful examination of the retinal vascular findings in all patients with toxemia has been recorded. This was possible because of close collaboration between the departments of Obstetrics and Ophthalmology. The purpose of this communication is to review these observations and correlate them with the other findings in the toxemias. Some of the more pertinent reports concerning retinal abnormalities in the toxemias, present standards for retinal changes, and the classification of the toxemias will be briefly reviewed. It is hoped that certain refinements in the management of the toxemias may result following the evaluation of these data.

Fetal mortality in cesarean section.

A REDUCTION in maternal morbidity and mortality associated with cesarean section has been evident during the recent five-year period. This has been primarily related to the development of more satisfactory surgical techniques, rapid blood replacement, and the use of antibiotics.*, 2 Because of the improved maternal results associated with the operation, an expansion in the indications for the procedure has occurred particularly during the past three years3 in an attempt to reduce fetal mortality. It is the purpose of this presentation to evaluate fetal deaths at the New York Lying-In Hospital following cesarean section during the period 1933 to 1949, inclusive. The causes of fetal death, the indications for the operation, the condition of the fetus prior to and after the operation will be elaborated. In this study, all sections are included in which the infant weighed 1,500 grams or over, regardless of the duration of the pregnancy. The premature group comprises the infants from 1,500 grams to 2,499 grams, and full-term infants include all of 2,500 grams and over. The infant mortality represents all dead births, stillbirths, and neonatal deaths. Stillborn are those with cardiac sounds at birth without respirations. Neonatal deaths include all deaths of infants prior to the fifteenth day of life.A REDUCTION in maternal morbidity and mortality associated with cesarean section has been evident during the recent five-year period. This has been primarily related to the development of more satisfactory surgical techniques, rapid blood replacement, and the use of antibiotics.*, 2 Because of the improved maternal results associated with the operation, an expansion in the indications for the procedure has occurred particularly during the past three years3 in an attempt to reduce fetal mortality. It is the purpose of this presentation to evaluate fetal deaths at the New York Lying-In Hospital following cesarean section during the period 1933 to 1949, inclusive. The causes of fetal death, the indications for the operation, the condition of the fetus prior to and after the operation will be elaborated. In this study, all sections are included in which the infant weighed 1,500 grams or over, regardless of the duration of the pregnancy. The premature group comprises the infants from 1,500 grams to 2,499 grams, and full-term infants include all of 2,500 grams and over. The infant mortality represents all dead births, stillbirths, and neonatal deaths. Stillborn are those with cardiac sounds at birth without respirations. Neonatal deaths include all deaths of infants prior to the fifteenth day of life.

The relaxant effect of diazoxide on nongravid human myometrium in vivo

Abstract Diazoxide, a benzothiadiazide derivative, was injected intravenously in 18 patients to determine its relaxant properties in the nongravid human uterus. Uterine motility was continuously monitored by the “closed-end catheter” technique. Diazoxide was given in doses of 150 to 370 mg. primarily by a single rapid injection. This compound was found to be a potent uterine relaxant in all trials. Spontaneous and oxytocin-induced uterine motility were inhibited as long as 4 hours. Likewise, diazoxide reduced the responsiveness of the uterus to oxytocin. Side effects were minimal and were limited to a transient tachycardia with little change in blood pressure. It is suggested that diazoxide may act by displacing calcium at the receptor site, since its relaxant effect resembles the rapid response of magnesium and prevents the action of oxytocin.

The inhibitory effect of diazoxide in normal term labor

Abstract Diazoxide, a smooth muscle relaxant, was administered to 16 patients with intact membranes in normal term labor. The drug reduced both the intensity and the frequency of uterine contractions in a direct relationship to the amount administered. The cardiovascular effects were a dose-related rise in maternal heart rate and a transient hypotension which was dependent on individual sensitivity to the drug. No adverse effects on the fetus were observed. The ability of diazoxide to inhibit myometrial activity may be of therapeutic value.

A two-man experience with the copper “T” intrauterine device

Abstract The contraceptive effectiveness and the incidence of side effects of the Copper T Model T Cu200 in 396 women was studied by a two-man team in a private clinic. There were six pregnancies, a rate of 2.7 per 100 woman years of use, which were associated with either expulsion or displacement of the IUCD. The expulsion-displacement was higher in the immediate postpartum insertions, and in the nulligravid group. The implications of these findings are discussed, and visible and invisible displacement of the IUCD are illustrated. Twenty IUCDs were removed for medical reasons primarily menorrhagia and/or metrorrhagia. There were 9 removals for non-medical reasons, mainly because of desired pregnancy. Menorrhagia and intermenstrual spotting were the most frequently reported side effects of the copper T. There was a drop in the incidence of reported side effects as the months of use increased with the exception of metrorrhagia in the gravid group. The significant advantages of the Cu T are its high acceptability in the nulligravid, the reduced bleeding, and the ease of insertion.