Volume

125

Communications

Number4

Fig. 5. L + 0.5-Longitudinal (large arrow) marker.

and extension

scan 0.5 cm. to left of midline demonstrating into perivesicular

The ultrasonic appearance of this mass on transverse scans is that of an abdominal wall hematoma in its most cephalad portion (S + 20) (Fig. 1); a combined abdominal wall and bilateral rectus sheath hematoma in its mid portion (S + 12) (Fig. 2); and a rectus sheath hematoma with extension inferiorly into the perivesicular space in its lower portion (S + 4 and S + 2) (Figs. 3 and 4). Longitudinal examination 0.5 cm. to the left of the midline demonstrates the rectus sheath hematoma and the extension into the perivesical space (L + 0.5) (Fig. 5). The ultrasonic characteristics of this mass differ from true cystic masses in that the anterior and posterior borders are not as well defined as seen with true cystic masses. Internal ethos are well demonstrated in the hematoma. No other radiographic or surgical procedures were deemed necessary for diagnosis and thus the morbidity associated with some of these other procedures was avoided. This case is presented to demonstrate a safe, well-tolerated diagnostic procedure for evaluating the patient with an abdominal mass. Its location and size are well localized by B-scan ultrasound. REFERENCES

1. Hildreth, D. H.: Anticoagulant therapy and rectus sheath hematoma, Am J Surg. 124: 80, 1972. 2. Titone, C., Lipsius, M., and Krakauer, J.: Spontaneous hematoma of the rectus abdominis muscle: Critical review of 50 cases with emphasis on early diagnosis and treatment, Surgery 74: 568, 1972.

space (wavy

arrow).

in brief

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rectus sheath hematoma

Umbilicus

is marked

by V-shaped

Pregnancy-zone protein present during pregnancy and hormonal treatment in women previously believed not to produce this protein M.-G.

DAMBER

B.

VON

T.

STIGBRAND

Department Physiological

SCHOULTZ

of Obstetrics Chemistry,

and Gynaecology and Department of University of Ume&, Umeil, Sweden

T H E B I o LO G I c A L significance of the highly increased concentration of the so called pregnancy-zone protein (PZP)’ during human pregnancy is unknown. The concentration of this estrogen-induced plasma protein is also increased during hormonal treatment in both women and men. In previous investigations, some individuals have been found not to produce PZP in measurable amounts. These “non-producers” are important when the physiology of pregnancy and the biological role of PZP are considered. Thus, it is not yet clear whether This Swedish Faculty,

work was financially Medical Research University of Umei,

supported by grants from the Council (4217), the Medical and the “Tore Nilssons fond for

Medical Research.” Reprint requests: Dr. Obstetrics and Gynecology, Umei, Sweden.

M.-G. Damber, Department University of Umei, S-901

of 87,

566

Communications

June Am. J. Obstet.

in brief

20,.

100ml

mg

15, 1976 Gynecol.

serum

19,. 18 ** 17.. 16 *. 15 -. 14 a’ 13 a. 12 ‘. 11 -* 10 ‘. 9 ,. 8 .. 7 *. 6 ‘* 5 .’ 4 *’ 3 ‘I 2 ‘. 1 t

I 5

Weeks

10

of

15

20

25

30

35

Fig. 1. Variation in the serum concentration of PZP in five “nonproducing” during pregnancy. Delivery is indicated by p.

mg/PZ

100 ml

serum

n-9

I I

n -18

0

Months

1

3

40

gestation

6

of treatment

Fig. 2. Concentration of PZP (mean I standard error triangle) in sera of “nonproducing” women before and during treatment with norgestrel, 0.5 mg., and ethinyl estradiol, 0.05 mg. The number ofinvestigated women is indicated by n.

women

(0. ., ;II, a, and A)

some individuals really lack PZP or if it is present in very low concentrations. Furthermore, it is unknown whether these individuals really do not react during pregnancy and hormonal treatment with production of PZP. In the present investigation, women previously classified as “nonproducers” (PZP, less than 4 mg. per 100 ml.) were reinvestigated by means of a newly developed, highly sensitive (150 ng. per milliliter) radioimmunoassay for PZP. In a previous study of 72 primigravid women, the serum concentration of PZP was followed during pregnancy and after delivery.’ With single radial immunodiffusion, nine women did not show measurable amounts of PZP. Each woman was tested between nine and 13 times during pregnancy and after delivery. From another group of 103 women receiving oral contraceptives,3 18 individuals previously classified as “nonproducers” were reinvestigated. These women were treated with 0.5 mg. of norgestrel and 0.05 mg. of ethinyl estradiol.* Samples were taken prior to treatment and after one, three, and six months, respectively. In Fig. 1 the serum concentration of PZP during pregnancy and after delivery is shown for five of nine primigravid women, previously classified as “nonproducers.” All nine women were found to have *Ovral, Wyeth P. 0. Box 8299,

Labs., Div. American Home Products Philadelphia, Pennsylvania 19101.

Corp.,

Volume Number

125 4

measurable amounts of PZP. The concentration was found to increase with gestational length with a considerable individual variation. During the third trimester, values between 3 and 20 mg. per 100 ml. were recorded. After delivery, a rapid decrease was found. Eight weeks post partum, no values exceeding 4 mg. per 100 ml. were obtained. The mean values of the serum concentration of PZP for the I8 “nonproducing” women receiving oral contraceptives are shown in Fig. 2. Prior to treatment all women were found to have measurable amounts of PZP, 0.7 :t 0.1 mg. per 100 ml. (mean value * standard error of the mean). After one month of treatment, a significant increase was observed, the mean value reaching 1.7 +- 0.3 mg. per 100 ml. (P < 0.01). The mean value after three months of treatment, 2.8 + 0.5 mg. per 100 ml., indicates a further increase from one to three months; however, it was not statistically significant (0.05 < P < 0.10). Thereafter the PZP concentration was more stable with a mean value of 2.5 + 0.8 mg. per 100 ml. after six months of treatment. ‘Thus, in this study all “nonproducers” were found to have measurable concentrations of PZP. Furthermore, during pregnancy or hormonal treatment all of these women were found to have increasing amounts of this protein. The average concentrations were low but the relative increase and the shape of the curves (Figs. 1 and 2) were quite similar to the results obtained for women producing higher amounts of PZP. During the third trimester, all nine pregnant women in this study had a concentration of at least 3 mg. per 100 ml. In a previous investigation, individual values as high as 300 mg. per IO0 ml. have been recorded for the corresponding period of pregnancy. All 18 women receiving oral contraceptives also were found to have PZP in measurable concentrations when they were examined before treatment. This indicates that PZP is present in low amounts in all women. In fact, this observation seems to be confirmed by recent data. Estrogen is important for the production of PZP. The increase of this protein, found during hormonal treatment, is affected by the type and dosage of the drug. Also during pregnancy a marked increase with gestational length is observed. These observations suggest a straight estrogen dose-response relationship for the production of PZP. However, the high estrogen levels during pregnancy do not always elicit high concentrations of PZP. On the other hand, comparatively low levels of estrogen, i.e., during hormonal treatment, can induce high concentrations of PZP. Thus, the individual response to estrogen stimulation with respect to the production of PZP seems to be as important as the concentration of estrogen. The previously reported fraction of individuals, the “nonproducers,” should be referred to as “low producers.”

Communications

An increase in the concentration physiologic response to estrogen

in brief

of PZP should stimulation.

567

be a

Thanks are due to Prof. Per Lundstrijm for stimulating criticism and advice. Skillful technical assistance was provided by Mrs. K. Hjortsberg, Mrs. M. Isaksson, and Mrs. M. Wallen.

REFERENCES

1. van Schoultz, B., and Stiabrand, T.: Biochim. Biophys. Acta 359: 303, 1974. 2. van Schoultz, B.: AM. J. OBSTET. GYNECOL. 119: 792,1974. 3. Damber, M.-G., von Schoultz, B., Solheim, F., and Stigbrand, T.: AM. J. OBSTET. GYNECOL. 124: 289, 1976.

In utero traumatic intra-abdominal deceleration injury to the fetus-A report

case

E. CONNOR J. CURRAN Departments University Florida

of Obstetrics and Gynecologli and Pediatrics, of South Florida College of Medicine, Tampa,

THE ST RI DE s achieved in recent years in the reduction of neonatal morbidity and mortality rates have made fetal death and injury due to trauma sustained in utero as an automobile passenger a more significant cause of perinatal death. The most common injuries occurring in the fetus have been intracranial hemorrhage and skull fractures.im6 Such injuries to the fetus have implicated the conventional automobile lap belt as the causative agent in many cases.1-7 Lap belts have also been implicated in intestinal and mesenteric injuries in the adult that have been characterized as the “seat belt syndrome.“’ Lap belts have been widely accepted as reducing morbidity and death by the reduction of ejection from the vehicle and secondary impacts within the vehicle. Crosby and associate@ 5 and Porter and Green” have shown that fetal and maternal death and morbidity were not increased by the use of lap belts in pregnancy. The type and manner in which belts are worn has been shown to correlate with the extent of passenger injuries. The diagonal shoulder belt restraint has been associated with a lesser degree of abdominal injury than the single lap type belt.g Gravid patients should wear seat belt restraints under the uterus rather than over the fundus Blunt abdominal trauma to the gravid uterus has Reprint requests: Dr. John S. Curran, College of Medicine, University of South Florida, Tampa, Florida 33620.

Pregnancy-zone protein present during pregnancy and hormonal treatment in women previously believed not to produce this protein.

Volume 125 Communications Number4 Fig. 5. L + 0.5-Longitudinal (large arrow) marker. and extension scan 0.5 cm. to left of midline demonstrating...
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