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Contractions of a nonpregnant multiparous human uterus
RUCKER
:
CONTRACTIONS
OF
NONPREB~AST
MIJI,‘lX’AROUS
UTERUS
255
Tjlat this tumor was located in the ova.ries seemed perfectly clear to me at the time of operation, for the masses on both sides still One could roughly resembled the ovary, both in contour and position. clearly see both fallopian tnbcs stretched across the anterior surfaces of the tumors from which they could bc easily separated. Had the tumor come primarily from a structure in t,hc broad ligament, I feel certain that some vestige of an ovarian structure would have been visible on one side or the other. We have then, a growth which tends toward a sarcomatous and carcinomatous type in one and the same section, which arises from the rndothelium of the lymphatics, arranges itself in concentric, perivascular cell groups, has the polyhedral or cuboidal, always polymorphic cell type, and is of a malignant character. The arrangement in whorls or chains, the tendency to formation of vacuoles which coalesce to form new spaces, seemingly lined by tumor cells, all these points seem to indicate that the diagnosis of malignant endothelioma of perithelioma type, is here justified. I am deeply indebted to David H. Dolley, Professor of Pathology at St. Louis University, for his kindness and help in the study of the pathologic material presented in this paper, as well as for the original tissue diagnosis, I wish also to express my thanks to H. P. Muir, now of University of Missouri, Columbia, for his painstaking and very complete autopsy report, and to C. W. S&erg, of the City Hospital, for his examination of the original tissue in the diagnosis of which he independently confirmed our findings. 501 METROPOLITAN
CONTRACTIONS
BUILDING.
OF A NONPREGNANT HUMAN
BY M.
PIERCE
RUCRER,
MUI,TlPAROUS
UTERUS M.D.,
RICEISIOSD,
Vh.
NUMBER of observers, notably Kehrcr,]” Franz,6 Kciffcr,‘” A Jacub,12 Fellner,4 Langley and Anderson,17 Gunn,s Dale,3 Blair,l and Keye,l” ha.vo published studies of the eontractions of the uterus of animals. These authors used either strips of tissue as in the ordinary muscle preparation, or else observed the organ in situ. Helme1° studied the excised sheep’s uterus perfused with Locke’s solution and Kurdinowski16 the uterus of dogs in. the same manner. In two instances he observed the entire act of parturit,ion after the uterus had been removed. Cushny” found that the pregnant uterus and usuall? one that had been pregnant, underwent regular rhythmic contractions. The virgin uterus, however, when, the abdomen was opened under warm saline, showed no movements. When the virgin uterus was exposed to air or handled roughly, it also showed contmctions. ,Recently Keyc? and Blair1 hare shown that in the domestic pig and in
256
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
the rat there are two types of spontaneous contractions of t,he nonpregnant uterus, large and small. ICeye’” states that “during the time the graafian follicles are maturing and for a short time after they burst, contractions of the major type predominate. When the corpora lutea reach maturity and up to a time shortly befort they retrogress, the minor contractions predominate or are present alone. ” Franq6 Gunn,7 and Flux-y” have studied the contractions of strips of human uterus, both pregnant and nonprcgnant. Schat,z,‘” PolailA 1011,~~Hensen,l* Haskelle and Ru~kcr*~ have published tracings of VOIItractions of the pregnant human uterus. I can find no record of an]
Chart
1
observations upon the contractions of the nonpregnant human uterus in situ. The accompanying hysterogram was obtained from a patient who was sent into the hospital with a diagnosis of inevitable abortion. She had missed four periods and had been bleeding for a week. Her doctor packed her with gauze two days before she entered the hospital and a,gain the day before she came in. When she entered the hospital a blood stained strip of gauze was removed from the vagina. The external OS was open, but the internal OS was firm and only slightly dilated. Under the impression that the patient was pregnant, I dilated the internal OS with a. Coodell’s dilator and introduced a No. 2 Voorhccs bag. I was nnahle to get the bag completely
RUCKER
:
CONTRACTIONS
OF
NONPRRQNANT
MULTIPAROUS
UTERUS
257
within the uterus. It was partially filled with water under a pressure of 250 mm. of Hg. and connected wit,h a kymograph. The bag adjusted itself so that the prcssurc fell to 106 mm. of Hg. Without disconnecting the bag from the manometer, I forced enough lysol solution into the system to raise the pressure to 256 mm. of Hg., but, the pressure soon fell to 100 mm. of IIg. This was again repeated with the same result. Each time when the pressure fell to about 14’:) mm. of Hg. the writing point began to show uterine contractions. The contractions varied in force from 18 to 36 mm. of Hg. and occurred The duration comparatively regularly at four minute intervals. averaged two minutes. The relaxation was much slower than in a pregnant uterus and occurred in a jerky manner strongly suggesting the smaller contractions that Keye described in the nonpregnant pig. Unfortunately I was unaware of the true state of the uterus at the time and the drum was running much too slowly to show these minor contractions well. Daring the time the record was being made the patient was uncomfortable, but had nothing that co~~lcl bc construed by as a true labor pain. She was given half ounce of paraldehyde bowel which put her to sleep but which had no effect, upon the uterine contractions. When the bag came out there was enough dilatation to permit my exploring the ,uterine cavity with my finger. The cavity was smooth and only a little enlarged. It was cur&ted and the curettings showed microscopically very little endometrium. The glands were straight and were lined by low columnal ciliated epithelium, and the stroma was dense and compact. It would seem therefore that the nonpregnant multiparous human uterus in situ is capable of rhythmic contractions under certain conditions. The contractions are comparable in both force and freThey however. quency to those that occur in the first stage of labor. certainly in this case, differed in that the relaxation was slower and was accompanied by secondary waves. What part the gauze packing played in making the uterus more irritable is of course problematical. REFERENCES
(1) Anat. Rword, 1922, xxiii, 9. (2) Jour. Physiol., 1906-7, xxx, 1. (3) Jour. Physiol., 1906, xxxiv, 163. (4) Arch. f. Gyniik., 1906, lxxx, 237. (5) Ztschr. f. Geburtsh. u. Gynlk., 1924, lxxxvii, 291. (6) Ztschr. f. Gehurtsh. u. Gynzk., 1904, liii, 361. (7) Proc. Roy. See., London, Series B. 1913-14, lxxxvii, 551. (8) Jour. Pharmaml. and Exper. Therap. 1913-14, v, 527. (9) AK JOUR. OBST. and GYNEC., 1922, iv, 608. (10) Laboratory Reports, Royal College of Physicians, Edinburgh, 1891, iii, 70. (11) Arch. f. Gyngk., 1898, Iv, 129. (12) Snat. u. Physiol. (Phys, abth.) 1884, p. 170. (13) Arch. f. Gynr%k., 1907, lxxxi, 160. (14) Recherclms sur (15) Bull. Johns Hopkins la physiokwe de l’ut&us, Bruxelles, H. Lamertin, 1896. 1904, lxxiii, 425. (17) Jour. Physiol., Hosp., 1923, XT&V, 60. (16) Amh. f. Gydk., 1895, xix, 122 and 372. (18) Arch. de Physiol. Norm. et Path., 1880, xii, 1. (19) AI@. JOUR. OBST. AND GYNEC., 1921, ii, 179. Air!. Torn. OBST. AXD GYKEC., 1922, iii, 134. (20) Arch. f. Gyliiik., 1872, iii, 58. MEDICAL
ARTS
BKJILDIW.
:
CONTRACTIONS
OF
NONPREB~AST
MIJI,‘lX’AROUS
UTERUS
255
Tjlat this tumor was located in the ova.ries seemed perfectly clear to me at the time of operation, for the masses on both sides still One could roughly resembled the ovary, both in contour and position. clearly see both fallopian tnbcs stretched across the anterior surfaces of the tumors from which they could bc easily separated. Had the tumor come primarily from a structure in t,hc broad ligament, I feel certain that some vestige of an ovarian structure would have been visible on one side or the other. We have then, a growth which tends toward a sarcomatous and carcinomatous type in one and the same section, which arises from the rndothelium of the lymphatics, arranges itself in concentric, perivascular cell groups, has the polyhedral or cuboidal, always polymorphic cell type, and is of a malignant character. The arrangement in whorls or chains, the tendency to formation of vacuoles which coalesce to form new spaces, seemingly lined by tumor cells, all these points seem to indicate that the diagnosis of malignant endothelioma of perithelioma type, is here justified. I am deeply indebted to David H. Dolley, Professor of Pathology at St. Louis University, for his kindness and help in the study of the pathologic material presented in this paper, as well as for the original tissue diagnosis, I wish also to express my thanks to H. P. Muir, now of University of Missouri, Columbia, for his painstaking and very complete autopsy report, and to C. W. S&erg, of the City Hospital, for his examination of the original tissue in the diagnosis of which he independently confirmed our findings. 501 METROPOLITAN
CONTRACTIONS
BUILDING.
OF A NONPREGNANT HUMAN
BY M.
PIERCE
RUCRER,
MUI,TlPAROUS
UTERUS M.D.,
RICEISIOSD,
Vh.
NUMBER of observers, notably Kehrcr,]” Franz,6 Kciffcr,‘” A Jacub,12 Fellner,4 Langley and Anderson,17 Gunn,s Dale,3 Blair,l and Keye,l” ha.vo published studies of the eontractions of the uterus of animals. These authors used either strips of tissue as in the ordinary muscle preparation, or else observed the organ in situ. Helme1° studied the excised sheep’s uterus perfused with Locke’s solution and Kurdinowski16 the uterus of dogs in. the same manner. In two instances he observed the entire act of parturit,ion after the uterus had been removed. Cushny” found that the pregnant uterus and usuall? one that had been pregnant, underwent regular rhythmic contractions. The virgin uterus, however, when, the abdomen was opened under warm saline, showed no movements. When the virgin uterus was exposed to air or handled roughly, it also showed contmctions. ,Recently Keyc? and Blair1 hare shown that in the domestic pig and in
256
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
the rat there are two types of spontaneous contractions of t,he nonpregnant uterus, large and small. ICeye’” states that “during the time the graafian follicles are maturing and for a short time after they burst, contractions of the major type predominate. When the corpora lutea reach maturity and up to a time shortly befort they retrogress, the minor contractions predominate or are present alone. ” Franq6 Gunn,7 and Flux-y” have studied the contractions of strips of human uterus, both pregnant and nonprcgnant. Schat,z,‘” PolailA 1011,~~Hensen,l* Haskelle and Ru~kcr*~ have published tracings of VOIItractions of the pregnant human uterus. I can find no record of an]
Chart
1
observations upon the contractions of the nonpregnant human uterus in situ. The accompanying hysterogram was obtained from a patient who was sent into the hospital with a diagnosis of inevitable abortion. She had missed four periods and had been bleeding for a week. Her doctor packed her with gauze two days before she entered the hospital and a,gain the day before she came in. When she entered the hospital a blood stained strip of gauze was removed from the vagina. The external OS was open, but the internal OS was firm and only slightly dilated. Under the impression that the patient was pregnant, I dilated the internal OS with a. Coodell’s dilator and introduced a No. 2 Voorhccs bag. I was nnahle to get the bag completely
RUCKER
:
CONTRACTIONS
OF
NONPRRQNANT
MULTIPAROUS
UTERUS
257
within the uterus. It was partially filled with water under a pressure of 250 mm. of Hg. and connected wit,h a kymograph. The bag adjusted itself so that the prcssurc fell to 106 mm. of Hg. Without disconnecting the bag from the manometer, I forced enough lysol solution into the system to raise the pressure to 256 mm. of Hg., but, the pressure soon fell to 100 mm. of IIg. This was again repeated with the same result. Each time when the pressure fell to about 14’:) mm. of Hg. the writing point began to show uterine contractions. The contractions varied in force from 18 to 36 mm. of Hg. and occurred The duration comparatively regularly at four minute intervals. averaged two minutes. The relaxation was much slower than in a pregnant uterus and occurred in a jerky manner strongly suggesting the smaller contractions that Keye described in the nonpregnant pig. Unfortunately I was unaware of the true state of the uterus at the time and the drum was running much too slowly to show these minor contractions well. Daring the time the record was being made the patient was uncomfortable, but had nothing that co~~lcl bc construed by as a true labor pain. She was given half ounce of paraldehyde bowel which put her to sleep but which had no effect, upon the uterine contractions. When the bag came out there was enough dilatation to permit my exploring the ,uterine cavity with my finger. The cavity was smooth and only a little enlarged. It was cur&ted and the curettings showed microscopically very little endometrium. The glands were straight and were lined by low columnal ciliated epithelium, and the stroma was dense and compact. It would seem therefore that the nonpregnant multiparous human uterus in situ is capable of rhythmic contractions under certain conditions. The contractions are comparable in both force and freThey however. quency to those that occur in the first stage of labor. certainly in this case, differed in that the relaxation was slower and was accompanied by secondary waves. What part the gauze packing played in making the uterus more irritable is of course problematical. REFERENCES
(1) Anat. Rword, 1922, xxiii, 9. (2) Jour. Physiol., 1906-7, xxx, 1. (3) Jour. Physiol., 1906, xxxiv, 163. (4) Arch. f. Gyniik., 1906, lxxx, 237. (5) Ztschr. f. Geburtsh. u. Gynlk., 1924, lxxxvii, 291. (6) Ztschr. f. Gehurtsh. u. Gynzk., 1904, liii, 361. (7) Proc. Roy. See., London, Series B. 1913-14, lxxxvii, 551. (8) Jour. Pharmaml. and Exper. Therap. 1913-14, v, 527. (9) AK JOUR. OBST. and GYNEC., 1922, iv, 608. (10) Laboratory Reports, Royal College of Physicians, Edinburgh, 1891, iii, 70. (11) Arch. f. Gyngk., 1898, Iv, 129. (12) Snat. u. Physiol. (Phys, abth.) 1884, p. 170. (13) Arch. f. Gynr%k., 1907, lxxxi, 160. (14) Recherclms sur (15) Bull. Johns Hopkins la physiokwe de l’ut&us, Bruxelles, H. Lamertin, 1896. 1904, lxxiii, 425. (17) Jour. Physiol., Hosp., 1923, XT&V, 60. (16) Amh. f. Gydk., 1895, xix, 122 and 372. (18) Arch. de Physiol. Norm. et Path., 1880, xii, 1. (19) AI@. JOUR. OBST. AND GYNEC., 1921, ii, 179. Air!. Torn. OBST. AXD GYKEC., 1922, iii, 134. (20) Arch. f. Gyliiik., 1872, iii, 58. MEDICAL
ARTS
BKJILDIW.