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A study of the urinary steroid profile during puerperium has been undertaken in order to supplement the knowledge gained from our previous investigations of the urinary determinations of pregnanolone, pregnanediol, pregnanetriol, and total estrogens during pregnancy. Seventeen patients with normal and abnormal pregnancies were studied. The results obtained indicate that pregnanolone and pregnanetriol originate mainly from fetoplacental precursors and confirm the similar origin of pregnanediol and total estrogens. This investigation suggests that a puerperium study can also give additional information in regard to the kidney function of the mother and the presence or absence of a functional ovary of pregnancy.

A study of the urinary steroid profile in early pregnancy has been undertaken in order to re-evaluate the usefulness of the urinary determinations of pregnanolone, pregnanediol, pregnanetriol, and total estrogens in cases of threatened abortion. This investigation incorporates an enzymatic hydrolysis with gas-liquid chromatographic analysis for the pregnane metabolites and an automated assay for total estrogens. The results obtained in 62 patients confirm the value of the urinary determinations of pregnanediol and pregnanolone. They also suggest that the prognosis is good in cases which present clinical symptoms of threatened abortion but have normal urinary excretion of pregnanediol and pregnanolone. When the “biochemical progestational activity,” as evaluated by the analysis of pregnanolone and pregnanediol remains normal, abortion does not occur in the first trimester.

SEVERAL methods have been developed in the past decade for the management of patients with repeated episodes of cardiac asystole or ventricular rates too slow to permit adequate perfusion of vital organs. Drug therapy has often proved disappointing. Recent emphasis has centered on various mechanical means of controlling the ventricular rate. Zoll and his co-workers1 have pioneered in the latter approach, employing external cardiac pacemakers that require relatively high voltage and current density. Skin burns have resulted from prolonged use — that is, for more than twenty-four hours. Severe pain has also been a problem. Weirich, Gott and Lillehei2 treated . . .

Sodium nitroprusside in 0.01 per cent solution was used to induce arterial hypotension in twenty-four consecutive craniotomies for cerebral aneurysm and arteriovenous malformations. The mortality and morbidity for patients with arteriovenous malformation and grade I and II aneurysm compared favourably with previous experience in this Institute using other methods. The results in patients with grade HI and grade IV aneurysms were not improved. It is considered that further support is given to the value of sodium nitroprusside as a safe agent for use in controlled hypotensive anaesthesia

The information afforded by continuous electrocardiographic and electroencephalographic monitoring is especially valuable during cardiac surgery. An abnormality seen in the electroencephalogram represents a summation of many influences affecting the brain and is not specific, but it tells when something is occurring that should be investigated. The promptness with which such changes follow a circulatory disturbance is illustrated by seven records made during operations in which the heart was arrested by injections of potassium citrate. The electrocardiogram showed the disorganization, cessation, and later resumption of cardiac activity; the electroencephalogram reflected the level of anesthesia, the effect of temperature changes, the state of the cerebral circulation, and the adequacy of respiration. These means help to maintain the necessary close rapport between the anesthetist and the essential physiological functions of the patient.

• A complete, temporary arrest of cardiac motion was induced and an almost bloodless operative field was obtained by the use of potassium citrate in 37 patients undergoing open-heart surgery. The largest group consisted of 18 children with congenital interventricular septal defect. The heart-lung machine, consisting of a pump and an oxygenator, was connected so as to remove blood from the venae cavae, oxygenate it, and return it to the aorta. The aorta was occuluded 2 or 3 cm. above the heart, and a mixture of 2 ml. of 25% potassium citrate solution with 18 ml. of blood was injected into the aorta proximal to the point of occlusion. The potassium citrate solution was injected until the heart stopped. If 20 ml. was not enough, more was injected. It was found that under these conditions the human heart could resume its normal action after periods of arrest as long as 40 minutes. The flaccidity of the heart facilitated extensive repairs, but distortions and tensions that were produced when large defects were closed sometimes resulted in tears elsewhere after the spontaneous beat was restored. The potassium citrate itself did not seem to introduce any new dangers. Of the 13 patients who died, three had transposition of the great vessels and one had a single ventricle. Twenty-four patients recovered. All of the nine patients who had the tetralogy of Fallot were in the group who recovered.