Progesterone and Abortion

Abstract

Latex agglutination test positive. Mantoux text 1/1,000 negative. E.S.R. 51 mm./hr. Repeated tests for L.E. cells negative. Serum albumin 3.3 g./ 100 ml. Serum globulin 3.5 g./100 ml. Electrophoresis showed increase in a2-and y-globulins. No real improvement followed medical treatment, and on October 11 Mr. L. L. Bromley explored the pericardium. No evidence of tuberculosis was found and the thickened parietal pericardium stripped easily. There was, however, 60 ml. of dark brown fluid in the pericardial sac and the visceral pericardium was markedly thickened and densely adherent to the myocardium. Both ventricles were unusually small. The parietal pericardium was largely resected, the fluid sucked out, and a very limited removal of the visceral pericardium carried out owing to the fibrous tissue extending deeply into the myocardium. Adhesions from the parietal pericardium to the apex and undersurface of the left ventricle were freed. Section of both layers of pericardium showed non-specific inflammatory changes and no evidence of tuberculosis. The pericardial fluid was sterile and contained only a few leucocytes: culture for Mycobacterium tuberculosis was negative. Operation was followed by a gradual fall in jugular venous pressure and disappearance of dyspnoea and oedema. Diuretics were continued for six months, but in May, 1962, all diuretic treatment was stopped without return of oedema or rise in jugular venous pressure.