Wm.J. Dieckmann

Etiology of eclampsia

Abstract We have not been able by obstetric and dietetic care to reduce the incidence of pre-eclampsia or prevent the development of an occasional case of eclampsia. The elimination of water given by the oral or intravenous route is delayed in all pregnant patients but more markedly in those with pre-eclampsia than in those who have hypertensive disease. This delay may be due in part to the increased storage of the water in the legs and thighs as a result of the high venous pressure in the lower extremities due to the pregnancy. The antidiuretic substance from the posterior pituitary and the hormones from the adrenal cortex are also involved but the mechanism of control is still in doubt. A urinary volume of 2,000 ml. per twenty-four hours is recommended as requiring minimal work by the normal kidney. The hourly ingestion of water in constant amounts of 150 to 200 ml. seems to produce better elimination of water, electrolyte and nonelectrolyte substances than the irregular ingestion of large amounts. It seems advisable to instruct normal patients not to ingest more than 1 to 2 Gm. of sodium, 4 to 6 Gm. of chloride, and 1 to 2 Gm. of potassium per twenty-four hours during pregnancy.

The treatment of pre-eclamptic edema with acetazoleamide (Diamox)

Abstract Diamox caused mild symptoms or signs in 4 patients (3 per cent). Since it is a sulfonamide, the possibility of precipitation in the kidney as well as leukopenia must be kept in mind. Diamox is a relatively safe drug for producing weight loss by increasing urine volume and urine sodium in pregnant patients with visible or occult edema (abnormal weight gain), pseudo-pre-eclampsia, hypertensive disease, and decompensated heart disease. Diamox has comparatively little effect on patients with true pre-eclampsia. The use of Diamox has some prognostic value in that a marked loss of weight due to a considerable increase in volume of urine and sodium excretion would suggest to us that the patient did not have pre-eclampsia-eclampsia but had water and electrolyte retention due to some other condition, possibly the pregnancy itself, multiple pregnancy, anemia, hypertensive disease, etc.

The inactivation of the antidiuretic hormone of the posterior pituitary gland by blood from pregnant patients

Abstract A simple method is presented for evaluating the antidiuretic effect of solution of posterior pituitary, using human subjects for the experiments. Our studies indicate that when Pitressin is incubated with blood from patients in the last half of pregnancy, the antidiuretic effect of Pitressin is absent or markedly diminished. Incubation with blood from nonpregnant patients evokes little change.

Etiology of pre-eclampsia-eclampsia. III. The effect of oral ingestion of sodium chloride and sodium bicarbonate by patients with toxemia of pregnancy.

Abstract Pregnant patients who showed too rapid weight gain, edema, hypertension, proteinuria, or various combinations of these signs were given sufficient identical 1 Gm. tablets ∗ of sodium chloride, sodium bicarbonate, ammonium chloride, or a placebo. Instructions were that they were to take 7 tables per day for one or more weeks and each patient was, if possible, to have taken the series of 4 tablets. In some patients, presumably those with true pre-eclampsia, the sodium ion, especially as sodium chloride, caused a definite increase in the weekly gain in weight, in the degree of edema, in the blood pressure, and in the proteinuria. However, in about 70 per cent of the patients there was no difference in the response to any of the four substances used. These studies of the oral and intravenous injection of sodium salts indicate that many patients who have signs of toxemia do not have true pre-eclampsia. We suggest the term “pseudo pre-eclampsia.” It is a waste of time to restrict the sodium intake of patients with pseudo pre-eclampsia as well as of many patients with hypertensive disease. Our work indicates a need for a better selection of patients and a more rigid restriction of the sodium ion in patients with true pre-eclampsia.

Serial studies of the cephalin flocculation and thymol turbidity tests in pregnant patients

Abstract This report does not imply that the liver may not be concerned in preeclampsia-eclampsia, because it undoubtedly is. It does indicate that the cephalin flocculation and thymol turbidity tests were within the normal range for the majority of patients who showed clinical evidence of pre-eclampsia with only two exceptions in which cases both tests were abnormal.

Serial Studies of Oxygen and Carbon Dioxide Content of Human Cord Blood.

Summary A method is described by which repeated samples of human cord blood can be obtained over a short period of time. Undue prolongation increases the risk of the operation. The oxygen content of fetal blood is appreciably increased by the administration of oxygen to the mother.

Tubal Ligation (Sterilization) by a Modified Madlener Method

565 Medlener-type tubal ligations were performed during the 6-year p eriod from July 1 1945-July 1 1951 with a pregnancy rate of 3.2%. 72% of the tubal ligations were performed within the first 24 hours of delivery. Tubal occlusion has been studied by use of lipiodol and tantalum tape left as markers for X-ray examination. Sodium morrhuate a sclerasing agent was used in addit on to the Madlener method in over 200 patients since the end of 1947. The procedure has been without failure.

Capillary fragility and the use of rutin in toxemias of pregnancy

Abstract The capillary fragility, using both the positive and negative pressure tests, has been studied in 164 cases of toxemia of pregnancy. Thirty-three per cent of the patients who we thought had essentail hypertension in pregnancy had an increased capillary fragility. The duration or the severity of the hypertension seemed to be of no significance. Pregnancy seemed to accentuate capillary fragility, possibly because of the relative or absolute anemia. Capillary fragility was not increased in patients who were thought to have preeclampsia, if the anemia was excluded. Abruptio placentae does not seem to be associated with an abnormal capillary fragility. Rutin was used in 13 patients, in 12 of whom it was found efficacious in reducing the increased capillary fragility.

Serum albumin fractions of different solubility and their relation to cancer

Abstract 1. 1. A method is described in which the more soluble albumin fraction is extracted with a 38.5 Gm. per cent ammonium sulfate solution from the serum proteins precipitated on a strip of filter paper. The total albumin was estimated by extraction of serum absorbed on a filter strip with a 31 Gm. per cent ammonium sulfate solution. The protein concentration in the extracts was measured turbidimetrically. On the average 100 ml. of normal serum contained 1.13 Gm. of the more soluble albumin fraction which represents about 25 per cent of the total albumin. 2. 2. The values for the more soluble albumin fraction, expressed as S = per cent of average values in normal sera, and the values for total albumin, expressed as T = per cent of average normal total albumin, were measured in 464 nonmalignancies and 82 malignancies. In addition S alone (without T) was determined in 320 nonmalignancies and 157 malignancies. 3. 3. For correlation with cancer diagnosis, S values were classified in two ways: first as high and low with respect to an intermediate zone which bears no relation to T, later as high and low with respect to a curve (Fig. 1) which represents the mean of the averages of S values in nonmalignancies and in malignancies for each T. The advantages of the later classification are pointed out. On the average the S values were 23 per cent lower in the sera from malignancies. Evaluation of the individual sera with the curve of means (Fig. 1) was correct in 89 per cent of the malignancies and in 77 per cent of the nonmalignancies. The correlation with the clinical evaluation of the success of treatment of gynecological carcinomas was correct in 98 per cent of the recurrences, and in 67 per cent of the nonrecurrences. 4. 4. During pregnancy S and T values decrease with the duration of gestation, in the last trimester they become indistinguishable from those of malignancies. 5. 5. Results from more recent studies indicate that the serological evaluation can be improved by a correction for the variations in the total protein/total albumin ratio.