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Avortements tardifs et accouchements prématurès
Volume .Vumber
79 4
terial
must
Book reviews
involve
the
elimination
of
much
detail and concentrate on a review type discussion. Assuming that the intelligent approach to differential diagnosis is based on a good understanding of pathologic physiology, the author begins by presenting the basic considerations in the study of abdominal pain discussing the latest advances in the knowledge of pain, its physiology and perception, especially as it relates to the abdomen and contained viscera. An attempt is made to apply these principles in the evaluation of, first, the medical diseases of the abdomen and its parietes and, second, the surgical diseases of the abdomen and pelvis. In spite of this attempt to separate the two types of pain, there is inevitable overlapping in the differential possibilities and the separation does not hold too well. Speaking from the gynecologist’s viewpoint, the disorders of the female pelvis seem to be summarily dismissed with a few short paragraphs which give the feeling that the differential diagnosis of pelvic disease is easier than we sometimes make it. A complete chapter is devoted to appendicitis, peritonitis, and abdominal abscesses, and other chapters include retroperitoneal causes of abdominal pain, systemic diseases remote from the abdomen causing abdominal pain, and an approach to chronic or recurrent abdominal pain.
Avortements tardifs t&s (Late
et accouchements
prtma-
821
established. Nor does Dr. Stamm believe that these levels can be raised by the administration of progesterone. Furthermore, he remains unconvinced of any inhibitory influence directly on human myometrium by progesterone. While he accepts the role of luteal disorders in early abortion, he questions whether this arises from an embryonal anomaly or is the cause of the threatened abortion. The author was struck by the fact that a majority of placentas studied after late abortion or premature delivery showed widespread inflammatory lesions that were not found following normal term deliveries of less than 12 hours’ duration, hysterotomies, etc. These lesions were considered to be the chief etiological factor in at least half of the late abortions. Their effect would, hypothetically, be by an oxytocic action by the pathogenic organisms themselves or their metabolic products on the myometrium, or by destruction of the epithelial elements of the chorion resulting in gonadotropin deficiency. Dr. Stamm presents some evidence to show that chorionic gonadotropin has an inhibitory influence on the uterus. Vaginal cytology is a cornerstone of the author’s diagnosis and management of threatened abortion. Disappearance of navicular cells, decrease of desquamated cells and, above all, an increase of the “eosinophil index” above 6 per cent are characteristic of threatened abortion. This index was carefully followed and correlated well with the evolution of normal and ab-
Abortions and Premature Deliveries). By Otto Stamm. 130 pages, 37 figures, 14 tables. Paris, 1959, Masson et Cie. 2,000 fr. Dr. Stamm’s contribution to the probletn of abortion and premature delivery is fresh and well reasoned and is based on careful clinical and laboratory research. Since the author believes that embryonal anomalies are one of the leading causes of first trimester abortion, his study is restricted to a
normal pregnancies studied, and was as unaffected by the administration of progesterone as it was usually brought to normal levels by the use of estrogen. Leukocytosis, and especially an accelerated erythrocyte sedimentation rate, particularly when the latter is rising, were taken as evidence of an inflammatory lesion of the membranes. Treatment, consequently, consists of progressively increased doses of estrogen if the eosinophil index is elevated and does return to normal in 10 to 20 days. This index, it
period seventh
was found, remains elevated in rare patients; this was taken as pathognomonic of both estrogen and progesterone deficiencies and carried a very poor prognosis. It should be pointed out that the rationale in giving estrogens is the belief that such therapy will promote uterine growth and vascularization rather than improve progesterone secretion. Treatment of inflammatory lesions consists of bed rest and antibiotics. The average hospital stay was 21 days.
ranging week
from the sixteenth to the thirtyof gestation. His results led him
to conclude that placental estrogen deficiency and inflammatory lesions of the fetal membranes are frequent causes of the abnormal onset of labor. The importance of progesterone deficiency and of progesterone therapy is minimized. Little correlation between pregnanediol levels and the eventual evolution of pregnancy can be
822
Book
reviews
An interesting point of view is Dr. Stamm’s treatment of the incompetent internal cervica1 0s by these measures, which yielded far better results than did the Shirodkar proctdurc. Ovcrall results during a 3 year period. with 1 IO paticnts, showed a rate of 84 per cent 0f viable babies born. This is contrasted with a rate of 55 per
cent after massive progcsteron~ th:xtpy. Adequate tables, graphs, microphotographs, and an extensive bihiiography ncc-nmpany 111~ study. Much of Dr. Stamm‘s rxxsoning, laboratory data, statistiral breakdown of clinical material; and related observations are worthy of mention but must be deleted for lack of spacp. It is to be hopc‘d that other clinicians will try 10 duplicate morr. to achieve
the author’s his results.
work
and,
even
sions
by interspersed the participants are throughout the book. In the past, the Icadirl,q cause of death trmr hypertensive disease has been cardiac failurt and malignant hypertension has been almost invariably fatal within months aftt,r its onset. However, several investigators reported, in thiq symposium, that cardiac failure has been prl:L-cnted (or at surgical con! rol remarked that patient dicl of Clinic for sornc: t;rcix and others.
Ii\?<:-year slirvivals liavc~ bt,conie cotri1non since> I he advent of ganglionic blocking agents and the &ective rmtrnl of the I)lood pressure: If’velu. The
Les
Trobles de la pubertk fkminine traitments. By J. E. Marcel. 43 figures, 20 tables. Paris, son et Cie. Compilation of diverse topics related
et leurs 366 pages, 1958, Masto puflrrty
in the female is prcsrntpd in a compact and thoroughly readahlc manner. The topics presented by the various authors cover a multitude. of subjects: some are purely clinical and have therapy as their primary goal, such as uterine hemorrhage of puberty, obesity of puberty, and dysmenorrhea in virgins. Some subjects, such as hirsutism, vaginal smears. and congenital malformations in the female are trt=ated in a more academic manner. It is interesting to note that several of the authors neglect the AngloSaxon literature almost entirely. while others refer t0 it t0 a considerable Hxtent. In general the stated endeavor 0f this hook is concisely prrscnted. It c.ontains :I considerable amount of information. Hypertension:
The First Hahnemann Symposium on Hypertensive Disease. Edited by John Moyer. 790 pages, illustrated. Philadelphia, 1959, W. B. Saunders Company. This interesting book covers the pathology, physiology, and clinical aspects of hypertension, concepts as to etiology, and treatment. There arc about 80 papers dealing with many phases of the disease and the pharmacology of hypotensive drugs. Some of the papers present new data and others are rxcellent reviews. Discus-
least postponed) t)y medical 01 of the blocld pressllrc*. Corcorau tic, had 1101. seen a hypcrtcnsivca hcai-t fGlurc~ at the CltAanci years past. This was affirmed 1,) .As for malignant hypr*rtensioll.
Physician and the Law. Liy Rowland T‘ong. Second edition. 302 pages. tables. New York. 1959, Appleton-Century-Crofts Inc. $5 . 05 ...
1-1. 9
In face of the alarl;iing incrensct in the numhel of malpractice clainls, the Publication of I,cmg’s second edition of 7’hc Pl&cian rind 111~ I,nx, is most timely. Sci~Gig a twofold purpose, this small volume gi\rrs t hc practicing physician some knowledge of the c&mental rules of law which govern the physician-patient relationshil) and may ~~11 serve him in g0cd stcud should hi br called upon
tn
act
2s
;I
\vltn('ss.
The chapters on malpractice, l~lood groups and transfusions, artificial insemination and adoption, as well as those relating to criminal la~z- arc simply written, easy to assimilate and full of usable facts. Data on privileged communications revcal some r:lth<>r sLartling iqnorance on the part r)f many patiisnts and their doctors in r+ gard to this oft-quoted but poorly understood area. While (‘l~‘lnt’lltill in presentation it is just such knowledge of th(, clrmcnts which could reverse the trends now making the practirr of medicine a high-risk profession. Long has doncx a distillguished and useful job in thr publicatian of this second edition of this small trst. An
Introduction to Gynecological Exfoliative Cytology-A Manual for Cytotechnicians. By Winifred I,iu. 12i pages, ,l-I figures. Springfield, I!j5!j, Charles (1 Thomas, Pltblinher. $&On. This is a small book 01‘ only I27 pagrs writtc-n for cytoteclinicians, and wcn for them it c’an bc
79 4
terial
must
Book reviews
involve
the
elimination
of
much
detail and concentrate on a review type discussion. Assuming that the intelligent approach to differential diagnosis is based on a good understanding of pathologic physiology, the author begins by presenting the basic considerations in the study of abdominal pain discussing the latest advances in the knowledge of pain, its physiology and perception, especially as it relates to the abdomen and contained viscera. An attempt is made to apply these principles in the evaluation of, first, the medical diseases of the abdomen and its parietes and, second, the surgical diseases of the abdomen and pelvis. In spite of this attempt to separate the two types of pain, there is inevitable overlapping in the differential possibilities and the separation does not hold too well. Speaking from the gynecologist’s viewpoint, the disorders of the female pelvis seem to be summarily dismissed with a few short paragraphs which give the feeling that the differential diagnosis of pelvic disease is easier than we sometimes make it. A complete chapter is devoted to appendicitis, peritonitis, and abdominal abscesses, and other chapters include retroperitoneal causes of abdominal pain, systemic diseases remote from the abdomen causing abdominal pain, and an approach to chronic or recurrent abdominal pain.
Avortements tardifs t&s (Late
et accouchements
prtma-
821
established. Nor does Dr. Stamm believe that these levels can be raised by the administration of progesterone. Furthermore, he remains unconvinced of any inhibitory influence directly on human myometrium by progesterone. While he accepts the role of luteal disorders in early abortion, he questions whether this arises from an embryonal anomaly or is the cause of the threatened abortion. The author was struck by the fact that a majority of placentas studied after late abortion or premature delivery showed widespread inflammatory lesions that were not found following normal term deliveries of less than 12 hours’ duration, hysterotomies, etc. These lesions were considered to be the chief etiological factor in at least half of the late abortions. Their effect would, hypothetically, be by an oxytocic action by the pathogenic organisms themselves or their metabolic products on the myometrium, or by destruction of the epithelial elements of the chorion resulting in gonadotropin deficiency. Dr. Stamm presents some evidence to show that chorionic gonadotropin has an inhibitory influence on the uterus. Vaginal cytology is a cornerstone of the author’s diagnosis and management of threatened abortion. Disappearance of navicular cells, decrease of desquamated cells and, above all, an increase of the “eosinophil index” above 6 per cent are characteristic of threatened abortion. This index was carefully followed and correlated well with the evolution of normal and ab-
Abortions and Premature Deliveries). By Otto Stamm. 130 pages, 37 figures, 14 tables. Paris, 1959, Masson et Cie. 2,000 fr. Dr. Stamm’s contribution to the probletn of abortion and premature delivery is fresh and well reasoned and is based on careful clinical and laboratory research. Since the author believes that embryonal anomalies are one of the leading causes of first trimester abortion, his study is restricted to a
normal pregnancies studied, and was as unaffected by the administration of progesterone as it was usually brought to normal levels by the use of estrogen. Leukocytosis, and especially an accelerated erythrocyte sedimentation rate, particularly when the latter is rising, were taken as evidence of an inflammatory lesion of the membranes. Treatment, consequently, consists of progressively increased doses of estrogen if the eosinophil index is elevated and does return to normal in 10 to 20 days. This index, it
period seventh
was found, remains elevated in rare patients; this was taken as pathognomonic of both estrogen and progesterone deficiencies and carried a very poor prognosis. It should be pointed out that the rationale in giving estrogens is the belief that such therapy will promote uterine growth and vascularization rather than improve progesterone secretion. Treatment of inflammatory lesions consists of bed rest and antibiotics. The average hospital stay was 21 days.
ranging week
from the sixteenth to the thirtyof gestation. His results led him
to conclude that placental estrogen deficiency and inflammatory lesions of the fetal membranes are frequent causes of the abnormal onset of labor. The importance of progesterone deficiency and of progesterone therapy is minimized. Little correlation between pregnanediol levels and the eventual evolution of pregnancy can be
822
Book
reviews
An interesting point of view is Dr. Stamm’s treatment of the incompetent internal cervica1 0s by these measures, which yielded far better results than did the Shirodkar proctdurc. Ovcrall results during a 3 year period. with 1 IO paticnts, showed a rate of 84 per cent 0f viable babies born. This is contrasted with a rate of 55 per
cent after massive progcsteron~ th:xtpy. Adequate tables, graphs, microphotographs, and an extensive bihiiography ncc-nmpany 111~ study. Much of Dr. Stamm‘s rxxsoning, laboratory data, statistiral breakdown of clinical material; and related observations are worthy of mention but must be deleted for lack of spacp. It is to be hopc‘d that other clinicians will try 10 duplicate morr. to achieve
the author’s his results.
work
and,
even
sions
by interspersed the participants are throughout the book. In the past, the Icadirl,q cause of death trmr hypertensive disease has been cardiac failurt and malignant hypertension has been almost invariably fatal within months aftt,r its onset. However, several investigators reported, in thiq symposium, that cardiac failure has been prl:L-cnted (or at surgical con! rol remarked that patient dicl of Clinic for sornc: t;rcix and others.
Ii\?<:-year slirvivals liavc~ bt,conie cotri1non since> I he advent of ganglionic blocking agents and the &ective rmtrnl of the I)lood pressure: If’velu. The
Les
Trobles de la pubertk fkminine traitments. By J. E. Marcel. 43 figures, 20 tables. Paris, son et Cie. Compilation of diverse topics related
et leurs 366 pages, 1958, Masto puflrrty
in the female is prcsrntpd in a compact and thoroughly readahlc manner. The topics presented by the various authors cover a multitude. of subjects: some are purely clinical and have therapy as their primary goal, such as uterine hemorrhage of puberty, obesity of puberty, and dysmenorrhea in virgins. Some subjects, such as hirsutism, vaginal smears. and congenital malformations in the female are trt=ated in a more academic manner. It is interesting to note that several of the authors neglect the AngloSaxon literature almost entirely. while others refer t0 it t0 a considerable Hxtent. In general the stated endeavor 0f this hook is concisely prrscnted. It c.ontains :I considerable amount of information. Hypertension:
The First Hahnemann Symposium on Hypertensive Disease. Edited by John Moyer. 790 pages, illustrated. Philadelphia, 1959, W. B. Saunders Company. This interesting book covers the pathology, physiology, and clinical aspects of hypertension, concepts as to etiology, and treatment. There arc about 80 papers dealing with many phases of the disease and the pharmacology of hypotensive drugs. Some of the papers present new data and others are rxcellent reviews. Discus-
least postponed) t)y medical 01 of the blocld pressllrc*. Corcorau tic, had 1101. seen a hypcrtcnsivca hcai-t fGlurc~ at the CltAanci years past. This was affirmed 1,) .As for malignant hypr*rtensioll.
Physician and the Law. Liy Rowland T‘ong. Second edition. 302 pages. tables. New York. 1959, Appleton-Century-Crofts Inc. $5 . 05 ...
1-1. 9
In face of the alarl;iing incrensct in the numhel of malpractice clainls, the Publication of I,cmg’s second edition of 7’hc Pl&cian rind 111~ I,nx, is most timely. Sci~Gig a twofold purpose, this small volume gi\rrs t hc practicing physician some knowledge of the c&mental rules of law which govern the physician-patient relationshil) and may ~~11 serve him in g0cd stcud should hi br called upon
tn
act
2s
;I
\vltn('ss.
The chapters on malpractice, l~lood groups and transfusions, artificial insemination and adoption, as well as those relating to criminal la~z- arc simply written, easy to assimilate and full of usable facts. Data on privileged communications revcal some r:lth<>r sLartling iqnorance on the part r)f many patiisnts and their doctors in r+ gard to this oft-quoted but poorly understood area. While (‘l~‘lnt’lltill in presentation it is just such knowledge of th(, clrmcnts which could reverse the trends now making the practirr of medicine a high-risk profession. Long has doncx a distillguished and useful job in thr publicatian of this second edition of this small trst. An
Introduction to Gynecological Exfoliative Cytology-A Manual for Cytotechnicians. By Winifred I,iu. 12i pages, ,l-I figures. Springfield, I!j5!j, Charles (1 Thomas, Pltblinher. $&On. This is a small book 01‘ only I27 pagrs writtc-n for cytoteclinicians, and wcn for them it c’an bc