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Cancer of the endometrium and prolonged estrogen therapy
ifkt:r‘6’
SELECTED
1083
ABSTRACTS
The formation of acid upon fertilization of some eggs, whether by sperm or artificially, is an important factor and fitted the above theory that a Change in pH of the egg produced The increased production of carbon dioxide or other acids a change in the redox potential. hypertonic and hypotonic solutions, in the egg, caused by such various methods as sperm, pricking, shaking or ultra violet light, was assumed by the author to be the cause of initiating development owing to changes in redox potential so produced. When eggs were placed in sea water or modified sea water, they lowered the Eh and the pH (hydrogen in concentration). This lolvering was more pronounced in modified sea water t,han in sea water. The redox potential of different species of eggs was different and changed with stages of development. In conclusion Brooks states there was a definite correlation between the rate of oxygen (Aonsumption of unfertilized and fertilized eggs and the redox potential of these eggs. The three groups of eggs studied illustrated the hypothesis that fertilization of the egg depended upon the correct ratio of oxidants to reductants of the enzyme systems. C. E. FOLSOME. Michelson,
Lewis:
Azoospermia:
An Analysis
of 146 Cases, J. Urol.
57:
512-518,
1947.
Michelson presents an excellently documented and detailed analysis of 146 cases of azoospermia which had been most csrefully studied. In sixty-nine cases, 47 per cent, the etiology was determined; in seventeen cases, 11 per cent, the cause could be shown only unilaterally; in sixty patients, 41 per cent, this factor could not be determined. The most’ frequent cause of degeneration of the spermatogenic cells was cryptorchidism, occurring in twelve cases, 8 per cent,.of the series. Mumps orchitis degenerative changes were seen in nine cases, 6 per cent of the series. The most frequent disease causing obstruction of the vase-epididymal duct was gonorrhea. This occurred in thirty-five cases, or 24 per cent of the series. Absence of both vasa was found in four cases. Testicular biopsy is deemed, by Michelson, as essential in diagnosis and determining treatment of azoospermia. His results of treatment were poor. He has seen not a single case show improvement after hormone therapy. In his hands only surgical measures have been successful and these are among the obstructive azoospermic cases. Three of eight cases showed sperm postoperatively and in two of these three cases the wife became pregnant. C. E. FOT,SOME.
Labor Strouse, Solomon, and Drabkin, Thiouracil, J. A. M. A. 131:
Charles: 1494,
Hyperthyroid&n
in Pregnancy
Treated
With
1946.
The authors report a ease of a 31-year-old primigravida with symptoms of hyperthyroidism following a thyroidectomy six years previously. The patient developed dyspnea, palpitation, tachycardia, and edema, and was placed on Lugol’s solution, digitalis and sedatives with only fair results. She was then placed on thiouracil 0.6 Gm. daily and in one week she was feeling fine. She entered the hospital with ruptured membranes and a breech presentation. She was delivered by a low cervical section under spinal anesthesia. The post-operative course was uneventful. The baby gave the impression of being hypothyroid. The baby’s subsequent development was perfectly normal. WILLIAM BERMAN.
Malignancies Fremont-Smith, Maurice, of the Endometrium
Miegs, Joe V., Graham, Ruth M., and Gilbert, Helen H.: Cancer and Prolonged Estrogen Therapy, J. A. M. A. 131: 805, 1946.
The authors review the literature uterus and the breast with the continued endometrical cancer in a woman undergoing
with reference to the carcinogenic effect use of estrogens. The authors report prolonged treatment with estrogen.
upon the a c,ase of
Howe,
Martha E., Madiumhemmct
and
Jennings, Mary Packing Met,hod,
Intrauterine A.: J. A. 11. Women’s
Irradiation, :f ,V odificat,ion 12. 2: 83, In-1T.
of t ht.
surgically, one should In cases of cancer of the uterine body which are not treated deliver a maximal radiotherapeutic dose to the entire cndometrium, and as deeply as possible into the uterine wall. In the irregular and distorted uterine cavity it is not possible tlr predetermine the location or extent of mucosal or myometrial extension. Since radium needles in tandem are not likely to deliver eEicient radiation, various methods of applicator distribution have been trircl. In 1939 the Radiumhemmet group (Sweden) began to pack the uterus with numbers of tubular steel casings containing radium salt.. This type of treatment, has resultetl in a 20 per crnt improvement in five-year results in those cases which had treatment by radiation alone. Howe and .Jennings, of thr New York lnflrmary, have devised and used a new type 01 and 8 mm. in maximum diameter, applicator. It, is shaped like an olive pit, ~0 mm. iu length (one size only). 1 t is closed by :t screw cap l~earing an eyelet for identifying tags. The shape permits penetrat,ion into the uterine cornu, close packing against neighboring applica!.ors, and the shape minimizes weak radiation at the entls, since applicators can overlap. Aboul ten applicators fill the uterus and cervical canal (dilatation of the cervix is maintained 1): the application in sit,u) . After insertion the patient is x-rayed to be sure that perforation has not occurred, ami to demonstrate good distribution of applicators. A dose of 1,000 gamma roentgens is delivered at a depth of 1.5 cm. at each of three treatments, with one supplemental treatment to the% vaginal vault and cervical portio by a vaginal applicator. The total dose to the uterus and vagina will vary from 3,300 to 6,000 milligram hours, depending on the size of these cavities. The total presumptive tumor dose, however, should be about the same in any case; about 3,000 gamma roentgens at 1.5 cm. depth and about 12,000 to 15,000 gamma roentgens at the endometrium. Experience with this method is limited as yet, and does not warrant conclusions as to its worth. JRVIKG L. FRANK
Anatomy Swenson,
Paul
fication,
C.: Anatomic Radiology 827:
Variations
in the Female Pelvis:
The Caldwell-Moloy
Classi-
1947.
In an editorial, Swenson discusses the paper of Nicholson and Allen (hncet 2: 192, 194ti). These authors have criticized the Caldwell-Moloy classification for lack of precision, and for limitless subclassification and multiplication of types. They seek to disprove that anthropoid and android pelves are associated with narrow outlets, or that t,he android pelvis is associated with difficult labor. Caldwell and Moloy, however, did not present these as const,nnt relationships. A large pelvis may not be dystocic whatever its shape, whereas in pelves of normal or borderline size, the pelvic form may be of prime importance. Nicholson and Allen believe that all pelvic deformities are due to malnutrition in childhood, but Swenson indicates that nutrition affects only the general size of a predetermined (hereditary or hormonal influences) type. Emphasis on size alone will probably not be as valuable as the dynamic method of Caldwell-Moloy, which in its size-shape analysis has been of great aid to obstetricians. IRVING L. FRANK.
SELECTED
1083
ABSTRACTS
The formation of acid upon fertilization of some eggs, whether by sperm or artificially, is an important factor and fitted the above theory that a Change in pH of the egg produced The increased production of carbon dioxide or other acids a change in the redox potential. hypertonic and hypotonic solutions, in the egg, caused by such various methods as sperm, pricking, shaking or ultra violet light, was assumed by the author to be the cause of initiating development owing to changes in redox potential so produced. When eggs were placed in sea water or modified sea water, they lowered the Eh and the pH (hydrogen in concentration). This lolvering was more pronounced in modified sea water t,han in sea water. The redox potential of different species of eggs was different and changed with stages of development. In conclusion Brooks states there was a definite correlation between the rate of oxygen (Aonsumption of unfertilized and fertilized eggs and the redox potential of these eggs. The three groups of eggs studied illustrated the hypothesis that fertilization of the egg depended upon the correct ratio of oxidants to reductants of the enzyme systems. C. E. FOLSOME. Michelson,
Lewis:
Azoospermia:
An Analysis
of 146 Cases, J. Urol.
57:
512-518,
1947.
Michelson presents an excellently documented and detailed analysis of 146 cases of azoospermia which had been most csrefully studied. In sixty-nine cases, 47 per cent, the etiology was determined; in seventeen cases, 11 per cent, the cause could be shown only unilaterally; in sixty patients, 41 per cent, this factor could not be determined. The most’ frequent cause of degeneration of the spermatogenic cells was cryptorchidism, occurring in twelve cases, 8 per cent,.of the series. Mumps orchitis degenerative changes were seen in nine cases, 6 per cent of the series. The most frequent disease causing obstruction of the vase-epididymal duct was gonorrhea. This occurred in thirty-five cases, or 24 per cent of the series. Absence of both vasa was found in four cases. Testicular biopsy is deemed, by Michelson, as essential in diagnosis and determining treatment of azoospermia. His results of treatment were poor. He has seen not a single case show improvement after hormone therapy. In his hands only surgical measures have been successful and these are among the obstructive azoospermic cases. Three of eight cases showed sperm postoperatively and in two of these three cases the wife became pregnant. C. E. FOT,SOME.
Labor Strouse, Solomon, and Drabkin, Thiouracil, J. A. M. A. 131:
Charles: 1494,
Hyperthyroid&n
in Pregnancy
Treated
With
1946.
The authors report a ease of a 31-year-old primigravida with symptoms of hyperthyroidism following a thyroidectomy six years previously. The patient developed dyspnea, palpitation, tachycardia, and edema, and was placed on Lugol’s solution, digitalis and sedatives with only fair results. She was then placed on thiouracil 0.6 Gm. daily and in one week she was feeling fine. She entered the hospital with ruptured membranes and a breech presentation. She was delivered by a low cervical section under spinal anesthesia. The post-operative course was uneventful. The baby gave the impression of being hypothyroid. The baby’s subsequent development was perfectly normal. WILLIAM BERMAN.
Malignancies Fremont-Smith, Maurice, of the Endometrium
Miegs, Joe V., Graham, Ruth M., and Gilbert, Helen H.: Cancer and Prolonged Estrogen Therapy, J. A. M. A. 131: 805, 1946.
The authors review the literature uterus and the breast with the continued endometrical cancer in a woman undergoing
with reference to the carcinogenic effect use of estrogens. The authors report prolonged treatment with estrogen.
upon the a c,ase of
Howe,
Martha E., Madiumhemmct
and
Jennings, Mary Packing Met,hod,
Intrauterine A.: J. A. 11. Women’s
Irradiation, :f ,V odificat,ion 12. 2: 83, In-1T.
of t ht.
surgically, one should In cases of cancer of the uterine body which are not treated deliver a maximal radiotherapeutic dose to the entire cndometrium, and as deeply as possible into the uterine wall. In the irregular and distorted uterine cavity it is not possible tlr predetermine the location or extent of mucosal or myometrial extension. Since radium needles in tandem are not likely to deliver eEicient radiation, various methods of applicator distribution have been trircl. In 1939 the Radiumhemmet group (Sweden) began to pack the uterus with numbers of tubular steel casings containing radium salt.. This type of treatment, has resultetl in a 20 per crnt improvement in five-year results in those cases which had treatment by radiation alone. Howe and .Jennings, of thr New York lnflrmary, have devised and used a new type 01 and 8 mm. in maximum diameter, applicator. It, is shaped like an olive pit, ~0 mm. iu length (one size only). 1 t is closed by :t screw cap l~earing an eyelet for identifying tags. The shape permits penetrat,ion into the uterine cornu, close packing against neighboring applica!.ors, and the shape minimizes weak radiation at the entls, since applicators can overlap. Aboul ten applicators fill the uterus and cervical canal (dilatation of the cervix is maintained 1): the application in sit,u) . After insertion the patient is x-rayed to be sure that perforation has not occurred, ami to demonstrate good distribution of applicators. A dose of 1,000 gamma roentgens is delivered at a depth of 1.5 cm. at each of three treatments, with one supplemental treatment to the% vaginal vault and cervical portio by a vaginal applicator. The total dose to the uterus and vagina will vary from 3,300 to 6,000 milligram hours, depending on the size of these cavities. The total presumptive tumor dose, however, should be about the same in any case; about 3,000 gamma roentgens at 1.5 cm. depth and about 12,000 to 15,000 gamma roentgens at the endometrium. Experience with this method is limited as yet, and does not warrant conclusions as to its worth. JRVIKG L. FRANK
Anatomy Swenson,
Paul
fication,
C.: Anatomic Radiology 827:
Variations
in the Female Pelvis:
The Caldwell-Moloy
Classi-
1947.
In an editorial, Swenson discusses the paper of Nicholson and Allen (hncet 2: 192, 194ti). These authors have criticized the Caldwell-Moloy classification for lack of precision, and for limitless subclassification and multiplication of types. They seek to disprove that anthropoid and android pelves are associated with narrow outlets, or that t,he android pelvis is associated with difficult labor. Caldwell and Moloy, however, did not present these as const,nnt relationships. A large pelvis may not be dystocic whatever its shape, whereas in pelves of normal or borderline size, the pelvic form may be of prime importance. Nicholson and Allen believe that all pelvic deformities are due to malnutrition in childhood, but Swenson indicates that nutrition affects only the general size of a predetermined (hereditary or hormonal influences) type. Emphasis on size alone will probably not be as valuable as the dynamic method of Caldwell-Moloy, which in its size-shape analysis has been of great aid to obstetricians. IRVING L. FRANK.