suggesting a second operation for removal of the uterus in these two patients, who are both aware of the necessity for close supervision. His final dogmatic statement reminds us of a correct diagnosis made by a medical student and missed by all the attending and house physicians. When asked how he arrived at the correct diagnosis of pancreatitis, he said, “Left upper quadrant pain, what else could it be!” M&in Be.&, M.D., F.A.C.0.G. Milton M. Dana, M.D., F.C.A.P. Philip Fleishman, M.D., D.-1.M. South Shore Surgical-Gynecological-Obstetrical Group, P.C. Islip Terrace Projessional Building Ill Carleton Avenue Islip Terrare, Long Island, Neuj York 11752
Immunologic
aspects of term pregnancy toxemia
To the Editors: I was very much interested in the article by Drs. Yang and associates, “Immunologic aspects of term pregnancy toxemia” (AM. J. OBSTET. GYNECOL. 122: 727, 1975). I would like to ask the authors whether they had occasion to examine the umbilical cords of these children. When the cord shows lesions of necrotic funiculitis, also called subacute funiculitis, an increase in immunoglobulin M, up to 1 to 2 Gm., is frequently observed, although no infection-bacterial, viral, or parasitic-can be demonstrated. These children are apt to have marked leukocytosis (up to 50,000 white cells); they show no clinical sign of infection, and, when they die (many of them are premature), no visceral, acute, or cicatricial lesion is found to suggest a recent or old infection. At any rate, the children treated with antibiotics are being given the biological elements. For some years I have been wondering whether such a picture does not correspond to a state of noninfectious immunity, but I am unable to clarify this problem from the anatomic standpoint. S. Sarrut, M.D. institut de Pwriculture Centre NewNatal (Pr. Satge) 26, Blvd. Brurw 75014 Paris, France
Reply to Dr. Sarrut To the Editow I appreciate the interest in my article. In order to answer the question raised in the letter, I again reviewed our data. In our study, as stated clearly in the article, we carefully excluded any case with possible infection, during either the gestation period or labor, since this would have interfered with the whole pur-
pose of our study. We observed 2 stillborn infants among the toxemia group, but we could only obtain cord blood from one; the immunoglobulin M level was 12 mg. per cent. The other stillborn infant was macerated; therefore, no cord blood could be obtained. The highest immunoglobulin M level among the babies born to mothers in the toxemia group was 83 mg. per cent. We did not observe any newborn infant Lvith lesions of necrotizing funiculitis and a highly elevated immunoglobulin M concentration. SewLiatj Yang, .W.D. The University oj Chicago Department oj Ob.ytetrics and Gynecolop The Chicago Lying-in Hospital 5841 Maryland Avenue Chicago,
Illinois
6063
7
Pituitary responsiveness to MeWzing hormone-releasing hormone (lH-WI) during pregnancy and the postpartum period To the Edit0r.s: I read with great interest the article, “Pituitary responses to LRH in the postpartum periods,” by Friedman and his associates.’ In this article, Dr. Friedman and his associates reported that no statistically significant changes in the levels of serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) could be demonstrated in five subjects on postpartum Day 1 or 3 and in the three subjects on postpartum Day 8 following a subcutaneous injection of 100 pg of synthetic LH-RH, and a normal elevation of LH and FSH following LH-RH injection was demonstrated in only one subject 36 days post partum. In our laboratory, pituitary responsiveness to LH-RH during pregnancy and the postpartum period was previously investigated, and the results were reported elsewhere. ‘, ’ S y nthetic LH-RH was administered intravenously in a dose of 200 pg to 14 normal pregnant women and 20 normal lactating women. Serum FSH was detectable but relatively low in al1 14 subjects in the first> second, and third trimesters of pregnancy. Moreover, exogenously administered synthetic LH-RH failed to stimulate serum FSH secretion from the anterior pituitary, and there was no rise in serum FSH in all 14 subjects throughout pregnancy. Synthetic LH-RH also failed to evoke FSH secretion in eight volunteers in the first postpartum week. About half of the six subjects in the third postpartum week responded to synthetic LH-RH with a rise of serum FSH and LH. All six lactating women in the fifth postpartum week were responsive to LH-RH, and there was a concomitant release in serum FSH and LH. The findings reported by Dr. Friedman and his associates are in agreement with the results of oul previous reports demonstrating a persistence of pitu-
Immunologic
aspects of term pregnancy toxemia
To the Editors: I was very much interested in the article by Drs. Yang and associates, “Immunologic aspects of term pregnancy toxemia” (AM. J. OBSTET. GYNECOL. 122: 727, 1975). I would like to ask the authors whether they had occasion to examine the umbilical cords of these children. When the cord shows lesions of necrotic funiculitis, also called subacute funiculitis, an increase in immunoglobulin M, up to 1 to 2 Gm., is frequently observed, although no infection-bacterial, viral, or parasitic-can be demonstrated. These children are apt to have marked leukocytosis (up to 50,000 white cells); they show no clinical sign of infection, and, when they die (many of them are premature), no visceral, acute, or cicatricial lesion is found to suggest a recent or old infection. At any rate, the children treated with antibiotics are being given the biological elements. For some years I have been wondering whether such a picture does not correspond to a state of noninfectious immunity, but I am unable to clarify this problem from the anatomic standpoint. S. Sarrut, M.D. institut de Pwriculture Centre NewNatal (Pr. Satge) 26, Blvd. Brurw 75014 Paris, France
Reply to Dr. Sarrut To the Editow I appreciate the interest in my article. In order to answer the question raised in the letter, I again reviewed our data. In our study, as stated clearly in the article, we carefully excluded any case with possible infection, during either the gestation period or labor, since this would have interfered with the whole pur-
pose of our study. We observed 2 stillborn infants among the toxemia group, but we could only obtain cord blood from one; the immunoglobulin M level was 12 mg. per cent. The other stillborn infant was macerated; therefore, no cord blood could be obtained. The highest immunoglobulin M level among the babies born to mothers in the toxemia group was 83 mg. per cent. We did not observe any newborn infant Lvith lesions of necrotizing funiculitis and a highly elevated immunoglobulin M concentration. SewLiatj Yang, .W.D. The University oj Chicago Department oj Ob.ytetrics and Gynecolop The Chicago Lying-in Hospital 5841 Maryland Avenue Chicago,
Illinois
6063
7
Pituitary responsiveness to MeWzing hormone-releasing hormone (lH-WI) during pregnancy and the postpartum period To the Edit0r.s: I read with great interest the article, “Pituitary responses to LRH in the postpartum periods,” by Friedman and his associates.’ In this article, Dr. Friedman and his associates reported that no statistically significant changes in the levels of serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) could be demonstrated in five subjects on postpartum Day 1 or 3 and in the three subjects on postpartum Day 8 following a subcutaneous injection of 100 pg of synthetic LH-RH, and a normal elevation of LH and FSH following LH-RH injection was demonstrated in only one subject 36 days post partum. In our laboratory, pituitary responsiveness to LH-RH during pregnancy and the postpartum period was previously investigated, and the results were reported elsewhere. ‘, ’ S y nthetic LH-RH was administered intravenously in a dose of 200 pg to 14 normal pregnant women and 20 normal lactating women. Serum FSH was detectable but relatively low in al1 14 subjects in the first> second, and third trimesters of pregnancy. Moreover, exogenously administered synthetic LH-RH failed to stimulate serum FSH secretion from the anterior pituitary, and there was no rise in serum FSH in all 14 subjects throughout pregnancy. Synthetic LH-RH also failed to evoke FSH secretion in eight volunteers in the first postpartum week. About half of the six subjects in the third postpartum week responded to synthetic LH-RH with a rise of serum FSH and LH. All six lactating women in the fifth postpartum week were responsive to LH-RH, and there was a concomitant release in serum FSH and LH. The findings reported by Dr. Friedman and his associates are in agreement with the results of oul previous reports demonstrating a persistence of pitu-
