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Antuitrin-s cutaneous test for the diagnosis of pregnancy
ANTUITRIN-S CUTANEOUS TEST FOR THE DIAGNOSIS OF PREGNANCY ISADORE GERSH, M.D., DENVER, COLO.
(From the Department of Clinical PathQlogy, University of Colorado School of
Medicine)
NUMEROUS attempts have been made to develop procedures for the early diagnosis of pregnancy which are simpler and more rapid than the highly accurate Aschheim-Zondek and Friedman biologic tests. Recently the intradermal injection of anterior pituitary-like hormone has been revived by Giliillen and Gregg1 as a ''new, rapid, economical test for pregnancy and certain gynecologic conditions.'' Most of the previous reports in the literature concerning the value of the test have been unfavorable. 2 Since the recent encouraging report by Gilfillen and Gregg is so at variance with the previous literature, we have carried out a series of tests to determine the value of the procedure. This study was carried out on 113 individuals. Fifty were normal men and nonpregnant women; 48 were known cases of pregnancy of two or more months' duration and fifteen were from one to nine days postpartum. Each subject received three intradermal injections; two of which were different preparations of the hormone, namely (1) antuitrin-S which is an extract of pregnancy urine prepared by Parke, Davis & Co., and (2) an anterior pituitary-like hormone extracted from placental tissue. • These have apparently identical physiologic effects but are derived from different sources. The third injection was a control consisting of normal saline with 0.5 phenol. Each injection amounted to two minims. In order to cheek the possibility of differences in reaction to preparations of separate dates, antuitrin-S from three lots and placental anterior pituitary-like hormone from two lots of manufacture were used in this study. The skin reactions were noted at intervals of one-half, one, and twenty-four hours following the injections. Results of the first two readings are shown in Table I. At the last reading, practically all subjects showed an area of erythema at the site of both the antuitrin-S and placental anterior pituitary-like hormone injections. From the results it is evident that there exists a marked discrepancy between the skin reacHons and the clinical diagnoses. The errors of the test consist in both false positive and false negative reactions. Using antuitrin-S, 20.8 per cent false negative results were obtained in our *The author wishes to express his appreciation for this material to Dr. R. W. Whitehead, Department of Physiology and Pharmacology, University of Colorado School of Medicine.
301
302
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
pregnant patients and 6.6 per cent in the postpartum cases, while 81.6 per cent of the men and 66.6 per cent of the nonpregnant women showed false positive tests for pregnancy (based on skin reactionR one hour after the injection). Purthermore, intradermal injections of phenolized normal saline gave definite erythematous r·eactions in 8.8 per cent of our subjects one-half hour after the injections a'nd in 5.4 per cent at one hour.
CLASSIFICATIOK
Postpar.ttrm Pregnant Men Nonpregnant 'Vomen
NUMBER EXAMINED*
CUTANgoeR REACTIONS
]I)
PERCENTAGE OF ERROR
ti(i.()
R3.3
R:l.:l
''Slllinc controls yielding positive renetiurw at one-half hour, 10: at one hout·, fi. tEased on the assumption that these should ~·leld negative cutaneous reactions. tA. P. L. H., P. D. & Co., Anterior pituitary-like hormone, Parke, Davis & Co. ~A. P. I,. H., Anterior pituitary-like hormone extra··tecl from placental ti~stw.
CO:\CLU::liO:\S
In our hands the anterior pituitary-like hormone (antuitrin-S) cutaneous test for pregnancy was found to he entirely unreliable. REFERE:'
(1) Gil fill en, G. C., and Gregg, W. J(.: A)L J. 0BST. & GYNE\C. 32: 498, 19i:W. (2) Queries and Minor Notes: .T. A. M. A. 108: 412, 1937. References to the liter· atur€' are given in this article.
Rivoir, J.:
Vaginal Secretion as a Cause of Primary and Recurring Cystitis, Monatschr. f. Geburtsh. u. Gynak. 105: 344, 1937.
As emphasized by Rivoir, infection of the urethra plays an important role in inflammation of the bladder. The urethra is infected not only by the gonococcu~ but also by the staphylococcus, streptococcus, colon bacillus, etc. The author lw· lieves that about 70 per cent of women who have a chronic infection of the genitalia also suffer from a nonspecific infection of the urethra. Cystoscopic examination in these women demonstrates a trigonitis which, in the chronic cases, produces no note· worthy symptoms. Hence the author favors treatment of all vaginal dischargeH as a prophylactic measure against non~pecific infPrtions of the urethra and trigonum. ,T. P. GREENHII,L.
(From the Department of Clinical PathQlogy, University of Colorado School of
Medicine)
NUMEROUS attempts have been made to develop procedures for the early diagnosis of pregnancy which are simpler and more rapid than the highly accurate Aschheim-Zondek and Friedman biologic tests. Recently the intradermal injection of anterior pituitary-like hormone has been revived by Giliillen and Gregg1 as a ''new, rapid, economical test for pregnancy and certain gynecologic conditions.'' Most of the previous reports in the literature concerning the value of the test have been unfavorable. 2 Since the recent encouraging report by Gilfillen and Gregg is so at variance with the previous literature, we have carried out a series of tests to determine the value of the procedure. This study was carried out on 113 individuals. Fifty were normal men and nonpregnant women; 48 were known cases of pregnancy of two or more months' duration and fifteen were from one to nine days postpartum. Each subject received three intradermal injections; two of which were different preparations of the hormone, namely (1) antuitrin-S which is an extract of pregnancy urine prepared by Parke, Davis & Co., and (2) an anterior pituitary-like hormone extracted from placental tissue. • These have apparently identical physiologic effects but are derived from different sources. The third injection was a control consisting of normal saline with 0.5 phenol. Each injection amounted to two minims. In order to cheek the possibility of differences in reaction to preparations of separate dates, antuitrin-S from three lots and placental anterior pituitary-like hormone from two lots of manufacture were used in this study. The skin reactions were noted at intervals of one-half, one, and twenty-four hours following the injections. Results of the first two readings are shown in Table I. At the last reading, practically all subjects showed an area of erythema at the site of both the antuitrin-S and placental anterior pituitary-like hormone injections. From the results it is evident that there exists a marked discrepancy between the skin reacHons and the clinical diagnoses. The errors of the test consist in both false positive and false negative reactions. Using antuitrin-S, 20.8 per cent false negative results were obtained in our *The author wishes to express his appreciation for this material to Dr. R. W. Whitehead, Department of Physiology and Pharmacology, University of Colorado School of Medicine.
301
302
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
pregnant patients and 6.6 per cent in the postpartum cases, while 81.6 per cent of the men and 66.6 per cent of the nonpregnant women showed false positive tests for pregnancy (based on skin reactionR one hour after the injection). Purthermore, intradermal injections of phenolized normal saline gave definite erythematous r·eactions in 8.8 per cent of our subjects one-half hour after the injections a'nd in 5.4 per cent at one hour.
CLASSIFICATIOK
Postpar.ttrm Pregnant Men Nonpregnant 'Vomen
NUMBER EXAMINED*
CUTANgoeR REACTIONS
]I)
PERCENTAGE OF ERROR
ti(i.()
R3.3
R:l.:l
''Slllinc controls yielding positive renetiurw at one-half hour, 10: at one hout·, fi. tEased on the assumption that these should ~·leld negative cutaneous reactions. tA. P. L. H., P. D. & Co., Anterior pituitary-like hormone, Parke, Davis & Co. ~A. P. I,. H., Anterior pituitary-like hormone extra··tecl from placental ti~stw.
CO:\CLU::liO:\S
In our hands the anterior pituitary-like hormone (antuitrin-S) cutaneous test for pregnancy was found to he entirely unreliable. REFERE:'
(1) Gil fill en, G. C., and Gregg, W. J(.: A)L J. 0BST. & GYNE\C. 32: 498, 19i:W. (2) Queries and Minor Notes: .T. A. M. A. 108: 412, 1937. References to the liter· atur€' are given in this article.
Rivoir, J.:
Vaginal Secretion as a Cause of Primary and Recurring Cystitis, Monatschr. f. Geburtsh. u. Gynak. 105: 344, 1937.
As emphasized by Rivoir, infection of the urethra plays an important role in inflammation of the bladder. The urethra is infected not only by the gonococcu~ but also by the staphylococcus, streptococcus, colon bacillus, etc. The author lw· lieves that about 70 per cent of women who have a chronic infection of the genitalia also suffer from a nonspecific infection of the urethra. Cystoscopic examination in these women demonstrates a trigonitis which, in the chronic cases, produces no note· worthy symptoms. Hence the author favors treatment of all vaginal dischargeH as a prophylactic measure against non~pecific infPrtions of the urethra and trigonum. ,T. P. GREENHII,L.