1383

(A) (C)

Liquid chromatography. (B) 10 ng/ml each ADR and ADR-OL DRB=daunorubicin, internal standard.

No ADR detected in amniotic fluid; ADR and ADR-OL in maternal blood.

respiratory distress which continued to get worse; she died 6 weeks later. Permission for maternal or fetal necropsy was denied. Amniocentesis was done 4 and 16 h after the first treatment. Fetal heart-rate, monitored intermittently, remained at 160/min. Maternal blood-samples were taken repeatedly; fetal blood could not be obtained. severe

After adding a known amount of internal standard (daunorubicin) the drugs were extracted from amniotic fluid and plasma samples with isopropanol-chloroform. The organic layer was evaporated to dryness, the residue was dissolved in the chromatographic eluent, and a sample was injected into a high-performance liquid chromatograph. A ’Zorbax-Sil’ column (Du Pont) was used in the isocratic mode at room temperature with an eluent flow rate of 1 -0 ml/min. The eluent was a mixture of chloroform:methanol:acetic acid:water (40:4:3:1 by volume). Peaks were detected with a fluorimetric detector operated at 482 nm excitation wavelength.

No doxorubicin was found in either amniotic fluid. Fig. 1A shows where doxorubicin (ADR) and adriamycinol (ADR-OL), its major metabolite, should have appeared. Fig. 1B shows the addition of 10 ng/ml of ADR and ADR-OL to amniotic fluid. This is the limit of detection under the experimental conditions given. Fig. 1C shows the serum ADR and ADR-OL levels obtained at the same time (4 h post-ADR injection) as the first amniotic fluid was taken; the peaks correspond to 27 ng/ml ADR and 18 ng/ml ADR-OL, respectively. Experience with chemotherapeutic agents during human pregnancy is limited. We were unable to find any reference to the use of ADR during pregnancy. The fact that we did not detect ADR in the amniotic fluid at 20 weeks’ gestation suggests that this agent is not transferred transplacentally to the fetus at this age. Although selective transport of ADR out of the amniotic fluid cannot be excluded, it is assumed that some ADR would have shown up in amniotic fluid, from fetal urination, if a sufficient concentration had been reached in the fetal circulation during the period of observation.

JOHN ROBOZ Departments of Neoplastic Diseases and Obstetrics and Gynecology, Mount Sinai School of Medicine of City University of New York, New York, N.Y. 10029, U.S.A.

NORBERT GLEICHER KONRAD WU PHILIPPE CHAHINIAN THOMAS KERENYI JAMES HOLLAND

PSYCHOGENIC URTICARIA

SiR,-Psychological factors are among the rare causes of urticaria. We have seen a patient in whom urticaria developed dramatically a few minutes after he had realised that he had’ been the victim of a business fraud. A 28-year-old man arrived at the hospital after realising that he had been defrauded. Within minutes of this realisation severe anxiety developed with sweating, headache, and nausea, and there was a sudden urticaria on the skin of the chest, back,

added

to

amniotic fluid;

and limbs. He had not taken any medicines during the previous week; he had not eaten any strawberries, to which he had been sensitive since childhood; nor was there any history of contact with chemicals. Other atopic reactions of the patient or his family unknown. On admission the patient was in a state of severe anxiety, sweating profusely, oedematous, and with slightly erythematous papules on the skin of the chest, back, abdomen, and limbs—clinical indications of urticaria. Pulse 60/min; blood pressure 110/60 mm Hg; temperature 37-2°C; laboratory tests normal. The patient was given tripelennamine hydrochloride tablets, and the urticaria subsided within about 5 h. Psychogenic factors can exacerbate urticaria, but there are doubts about whether they can be the sole cause. Few cases of psychogenic urticaria have been reported. The mechanism of this urticarial reaction is unknown. It has been reported that hypnosis can exert a partial inhibitory effect on the results of direct wheal and erythema skin tests and on passive transfer responses.1.2 The underlying factor in this and other similar cases may well be a direct, non-immunological effect on small vessels and their permeability. 1,2 M. PISTINER Department of Internal Medicine C, S. PITLIK Beilinson Medical Centre, Petach Tikva,

Israel

J. ROSENFELD

VENTRICULAR ECTOPICS AFTER SALBUTAMOL INFUSION FOR PRETERM LABOUR

SIR,-The introduction of &bgr;2-selective sympathomimetic drugs such as ritodrine, feneterol, and salbutamol has permitted inhibition of uterine contractions in premature labour with fewer effects on the mother’s cardiovascular system. We have been using salbutamol as a first-line tocolytic agent for over two years. In view of the potential hypokalaemic effect of salbutamol therapy, serum potassium concentrations are measured before therapy and 4-6 h afterwards. Most reports have concentrated on the metabolic side-effects of salbutamol therapy and on symptoms of tachycardia, palpitations, and hypotension, but we can find no previous report of electrocardiographic (ECG) abnormalities. A 24-year-old woman whose three previous pregnancies had ended in preterm labour at 24-30 weeks’ gestation (all three infants died) was booked into this unit at 26 weeks’ gestation in her fourth pregnancy. In view of the obstetric history, she was admitted for bed-rest and cervical cerclage. Her pregnancy was uneventful until the 34th week when mild to moderate 1. Black S. Shift in dose-response curve of Prausnitz-Küstner reaction by direct suggestion under hypnosis. Br Med J 1963; i: 990-92. 2. Black S. Inhibition of immediate-type hypersensitivity response by direct suggestion under hypnosis. Br Med J 1963; i: 925-29.

Psychogenic urticaria.

1383 (A) (C) Liquid chromatography. (B) 10 ng/ml each ADR and ADR-OL DRB=daunorubicin, internal standard. No ADR detected in amniotic fluid; ADR an...
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