Responses of the growth-retarded fetus to acute hypoxemia

Growth retardation in the human fetus associated with maternal cardiovascular disease is frequently accompanied by birth asphyxia and perinatal mortality. We have investigated the cardiovascular responses to acute hypoxemia in the fetal lamb with growth retardation secondary to embolization of the uteroplacental vascular bed. In the basal period, fetal arterial P_O2 and umbilical perfusion were significantly lower, and perfusion of the adrenal glands, brain, and heart was significantly higher, in embolized than in control fetal lambs. During imposed acute hypoxemia there was preferential perfusion of vital organs, the adrenal glands, brain, and heart in control and embolized fetuses. This preferential perfusion to the vital organs during hypoxemia was significantly more pronounced in embolized animals. Because of the increased compensation during acute hypoxemia, as reflected by the increased preferential perfusion of vital organs, the growth-retarded fetuses would probably decompensate sooner if the hypoxemia was prolonged.     

Successful treatment of leptomeningeal relapse of epithelial ovarian cancer

A case of isolated leptomeningeal recurrence of an epithelial ovarian cancer was recently diagnosed and treated successfully with methotrexate placed via an Ommaya reservoir in combination with radiation therapy. A review of the literature revealed no other cases of epithelial ovarian leptomeningeal malignancy similarly treated.     

美国补充替代医学研究的主要机构（二）——德克萨斯大学和旧金山加利福尼亚大学

医疗卫生领域正发生着一场安静的革命，包括美国人在内的世界传统医药消费日益增长。相应地，需要大量经过培训的专业人员来完成这种新的健康模式的转变，同时传统医学的作用机制及其安全性、有效性和质量控制的研究也得到大力加强。美国近年除了许多私立传统医学学校如雨后春笋般成立起来以满足曰益增长的对补充替代医学（complementary and alternative medicine，CAM）的需求外，许多著名大学也在积极参与甚至主导该领域的工作。     

The placenta: Immunologic or hemodynamic protector of the fetus?

Complete separation of the maternal and fetal circulation during normal pregnancy has been regarded as an extremely important protective factor from the immunologic standpoint. This hypothesis was tested in outbred rabbits in which a direct maternal-fetal parabiosis was established during the last week of pregnancy by implanting an intact maternal omental pedicle subcutaneously into the fetus. A functional cross-circulation, which developed after 48 hours as evidenced by maternal⁵¹Cr-labeled erythrocytes, led to pathologic changes culminating in fetal death within 70 to 80 hours postoperatively. Hyperacute graft rejection, previously postulated as the etiology of these fetal changes, was ruled out since the same characteristic syndrome occurred in similarly treated inbred fetuses syngeneic with their mothers. This study indicates that the absence of direct vascular intercommunication between mother and fetus at the level of the placenta is clearly necessary for physiologic as well as immunologic reasons.     

Treatment of advanced uterine sarcoma with adriamycin

Between 1971 and 1979, 39 patients with clearly measurable metastatic or advanced recurrent sarcoma of uterine origin were treated with Adriamycin, either alone or in combination with other chemotherapeutic drugs. The median survival was 7.2 months. No patient lived beyond 32 months from the start of chemotherapy. The response rate was 10.3% (10.3% partial responses and no complete responses). The median duration of a partial response was 4 months. There was no difference between the median survival of the responders and nonresponders.     

Expansion of the intravascular space in severe shock

Hypovolemic shock, if untreated for a while or if severe, results in an increase in intravascular capacity due to the opening of all capillaries at once. This expansion of the vascular capacity in patients with severe or untreated shock requires much more intravenous fluids for adequate treatment than the volume of blood lost. Fluid volume requirements should be determined by results (normal blood pressure and urinary output) and by central venous pressure or pulmonary arterial pressure for maximum tolerable administration. Blood volume measurements are useless. The vascular space shrinks to normal after adequate resuscitation, creating relative hypervolemia.     

Reoperation for aortic coarctation: techniques, results, and indications for various approaches

To define the safety and efficacy of operation for recurrent thoracic aortic coarctation, we reviewed the hospital records and subsequent courses of 53 patients who underwent such procedures over a 23-year period. Previous operations included end-to-end anastomosis, prosthetic patch or subclavian flap aortoplasty, and prosthetic interposition or bypass grafts, performed in patients ranging from 1 day to 44 years old. Several different reoperative procedures were used, including an ascending-descending aortic bypass graft in 4 patients who had had two previous repairs. There were no hospital or late deaths and only 3 relatively minor complications. Only 2 patients have hypertension requiring drug therapy at follow-up, which now averages 7 years. We conclude that operative management of severe, recurrent coarctation is both safe and effective, and that several techniques of reconstruction may have a place in such therapy.