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Dermatoses of the menopause
BELZXTED
536 S&e&
Eduardo Valenzuela: of CompNe Dilatation Obst. y ginec. latino-am.
Concerning in Certain 4: 280-288,
Am.J.Obrt.
ABBTRACT8
& Gynec.
March.
1947
the Physiopathology of the Cervix and a Modality of Dystocia of the Lower Pole of the Ovum,
Cases 1946.
The author believes that the character of cervical dilatation is a better criterion for the differentiation between the normal and pathologic courses of labor than are uterine contractions. He reviews the different factors involved in the process of normal delivery, and emphasizes the importance of correct preparation of the birth canal before labor begins. IIe studied the uterine contractions, the intraovular tension, the cervical musculature, thr loosening of the lower pole of the ovum, the bag of waters, and the engagement of the presenting part. He insists upon a peculiar modality in certain cases of dystocia of the lower pole of the ovum when the bag of waters is not properly ballooned out by the engagement of the presenting part. In such eases the dilatation of the cervix is complete, but the cervix has the The author believes that the appearance of a postpartum cervix in that it is totally relaxed. Therefore, he becondition is due to lack of engagement and is not inherent in the cervix. lieves that the baby should be extracted in such cases. Tbiis opinion is borne out, by the fact J. P. GREENHILL. that very few of the babies were born spontaneously. Perez,
Manuel Aburel’s
Lnis, Method,
and Baldi, Eduardo M.: Obst. y ginec. latino-am.
The Risks of the Induction 4: 8-19,
of Labor
by
Y&G.
The method of inducing labor adopted by Aburel, namely intra-ovular injection of serum, is popular in South America. The authors encountered three accidents in a series of twentyfire crises. In the first case, the baby showed marks of the needle puncture after delivery; in the second case, the mother died as the result of necrosis of the uterine wall followed by peritonitis, and in the third case the baby developed necrosis of the right leg which resulted in its death. The authors warn general practitioners against using the Aburel method because, in spite of the advantages of the transabdominal method of inducing labor, a drug which will be harmless for the mother and baby has not yet been discovered. J. I?. GREENHILL Cosende,
Julio
C.:
Breech
Presentation,
Bol.
Sot.
de obst.
y ginec.
24:
540-545,
1045.
At the Rosario Maternity Hospital in Buenos Aires from 1030 to 1944, there were 15,298 deliveries. Among them were 38d breech deliveries, an incidence of 4.35 per cent. The total fetal mortality Kas 21.42 per cent, of which 14.8 per cent were in primipams, and 6.42 per cent in multiparas. The author emphasizes that breech presentation should be considered In most cases x-ray studies should be made under the head of dystocia and not normal labor. during pregnancy and also during labor. Cesarean section is rarely selected for breech presentation alone, however, when there are additional factors such as contracted pelvis, placenta previa, and advanced age, cesarean section is indicated. J. P. GREENHILL.
Menopause Barber,
R.
W.:
Dermatoses of the Menopause,
Practitioner
156:
333, 1946.
A considerable number and variety of cutaneous changes and of symptoms referable to the skin appear in women near, during, and/or following the menopause, and at an earlier age in those with ovarian hypofunction. Moreover, certain dermatoses, which may occur from childhood to old age, in either sex, may be markedly influenced in their distribution and clinical manifestations, by the menopause. A good deal is known about the pathology of the menopausal and postmenopausal states, but there remains much unknown, particularly regarding the dermatoses. A great deal is known clinically; less, perhaps, therapeutically. However it is a well-established fact that by the judicious use of estrogens many symptoms referable to the skin and associate nervous system are successfully managed. It should be thoroughly umierstood, however, that estrogen therapy is not a panacea for “all and every”
Volume Number
5i 3
SELECTED
531
ABSTRACTS
menopause symptom, for it is a fact that many women do not exhibit strictly menopausal symptoms-and therefore do not need hormone treatment simply because they are passing through or have passed the climacteric, often many years previously. In conclusion, the author emphasizes that just because a patient is approaching or actually in the midst of the menopause, organotherapy is not necessarily indicated; that the most reliable method of administration is implantation under the skin of e&radio1 of one of the synthetic estrogens. This method is contraindicated, however, if the patient is still menstruating or has only recently ceased; that hypodermic administration is indicated where and that oral administration is less satisfactory rapid and intensified effect is desired; because of the fact that it is always questionable just how much absorption of the active Ointments containing a high concentration of principle is obtained through this route. synthetic estrogens are now available and, for certain of the dermatoses, this form of therapy HARVEY B. MATTHEWS. may be adequate.
Menstruation, Culiner,
A. : The Relation $ Gynaec. Brit. Emp.
of Theta-Cells 52: 545, 1945.
Dysmenorrhea, to Disturbances
etc. of the
Menstrual
Cycle,
J. Obst.
In a previous study it was shown that the baboon, when the theca cells surrounding the ovarian follicles proliferate or luteinize so extensively as to be visible to the naked eye as yellowish plaques or masses, there is often disturbance of the menstrual cycle. There has been much speculation as the endocrine function of the theca cells, especially in relation The author has made a study of the ovaries and uteri obtained at to theca-cell tumors. operation on women with excessive bleeding or other uterine evidence of endocrine disorder. Many of these patients were in the fourth and fifth decades of life, and had previously had normal cycles and pregnancies. Serial sections of the ovaries were examined. As the ovaries are removed as a rule only for some gynecologic complaint, it is difficult to establish the incidence of theta lutein cells other than those related to corpora lutea in the normal human ovary. In the author’s series, luteinized theca-cells were found more frequently than was anticipated, but their extent and distribution was not closely related to the severity of the menstrual disorder. The author proposes the following classification of theta-cell proliferations on the basis of their relation to various types of atresia. Group I, corpus theeale luteum, in which the original form of the follicle is retained; in one subgroup (a) granulosa cells may be absent or degenerating; in another subgroup (b) granulosa cells are luteinized. Group II, corpus thecale luteum fibrosum, in which granulosa cells are not present, absorption of liquor folliculi has taken place, connective tissue cells fill the cavity and may be surrounded by a hyaline ring; luteinized theta cells are external to this ring. Group III, corpus thecale luteum candicans, in which lutein reactions occur around a collapsed Group IV, corpus thecale luteum hyalinum, in which there is a lutein corpus atreticum. reaction around follicles that have collapse with hyaline tissue invading the cavity. Group V, corpus the&e luteum restiforme, in which a lutein reaction occurs around primordial or small maturing follicles. All these types of theea-cell proliferation with luteinization have been observed in the author’s material except Group V, which, however, is theoretically posIn this material a wide range of endometrial reactions and clinical disturbances was sible. observed, but those could not be correlated with the type of theca-cell luteinization observed in the ovary. In a few cases, normal endometria were found, although luteinized theta-cells were present in the ovaries, and there were menstrual disturbances. From these observations, the author concludes that theta-cell proliferation may occur as part of the process of maturation of the Graafian follicle. Luteinization of theea-cells around atretie follicles may be without clinical significance in ovulatory cycles, but in the presence of extensive thecal luteinization with follicular atresia, disturbances of menstrual rhythm and abnormal bleeding may occur. From the character of the uterine reactions found in association with proliferation of theca-cells, neither estrogenic nor progesteronic action oan be ‘definitely attributed to them. It is possible that they are responsible for a third
536 S&e&
Eduardo Valenzuela: of CompNe Dilatation Obst. y ginec. latino-am.
Concerning in Certain 4: 280-288,
Am.J.Obrt.
ABBTRACT8
& Gynec.
March.
1947
the Physiopathology of the Cervix and a Modality of Dystocia of the Lower Pole of the Ovum,
Cases 1946.
The author believes that the character of cervical dilatation is a better criterion for the differentiation between the normal and pathologic courses of labor than are uterine contractions. He reviews the different factors involved in the process of normal delivery, and emphasizes the importance of correct preparation of the birth canal before labor begins. IIe studied the uterine contractions, the intraovular tension, the cervical musculature, thr loosening of the lower pole of the ovum, the bag of waters, and the engagement of the presenting part. He insists upon a peculiar modality in certain cases of dystocia of the lower pole of the ovum when the bag of waters is not properly ballooned out by the engagement of the presenting part. In such eases the dilatation of the cervix is complete, but the cervix has the The author believes that the appearance of a postpartum cervix in that it is totally relaxed. Therefore, he becondition is due to lack of engagement and is not inherent in the cervix. lieves that the baby should be extracted in such cases. Tbiis opinion is borne out, by the fact J. P. GREENHILL. that very few of the babies were born spontaneously. Perez,
Manuel Aburel’s
Lnis, Method,
and Baldi, Eduardo M.: Obst. y ginec. latino-am.
The Risks of the Induction 4: 8-19,
of Labor
by
Y&G.
The method of inducing labor adopted by Aburel, namely intra-ovular injection of serum, is popular in South America. The authors encountered three accidents in a series of twentyfire crises. In the first case, the baby showed marks of the needle puncture after delivery; in the second case, the mother died as the result of necrosis of the uterine wall followed by peritonitis, and in the third case the baby developed necrosis of the right leg which resulted in its death. The authors warn general practitioners against using the Aburel method because, in spite of the advantages of the transabdominal method of inducing labor, a drug which will be harmless for the mother and baby has not yet been discovered. J. I?. GREENHILL Cosende,
Julio
C.:
Breech
Presentation,
Bol.
Sot.
de obst.
y ginec.
24:
540-545,
1045.
At the Rosario Maternity Hospital in Buenos Aires from 1030 to 1944, there were 15,298 deliveries. Among them were 38d breech deliveries, an incidence of 4.35 per cent. The total fetal mortality Kas 21.42 per cent, of which 14.8 per cent were in primipams, and 6.42 per cent in multiparas. The author emphasizes that breech presentation should be considered In most cases x-ray studies should be made under the head of dystocia and not normal labor. during pregnancy and also during labor. Cesarean section is rarely selected for breech presentation alone, however, when there are additional factors such as contracted pelvis, placenta previa, and advanced age, cesarean section is indicated. J. P. GREENHILL.
Menopause Barber,
R.
W.:
Dermatoses of the Menopause,
Practitioner
156:
333, 1946.
A considerable number and variety of cutaneous changes and of symptoms referable to the skin appear in women near, during, and/or following the menopause, and at an earlier age in those with ovarian hypofunction. Moreover, certain dermatoses, which may occur from childhood to old age, in either sex, may be markedly influenced in their distribution and clinical manifestations, by the menopause. A good deal is known about the pathology of the menopausal and postmenopausal states, but there remains much unknown, particularly regarding the dermatoses. A great deal is known clinically; less, perhaps, therapeutically. However it is a well-established fact that by the judicious use of estrogens many symptoms referable to the skin and associate nervous system are successfully managed. It should be thoroughly umierstood, however, that estrogen therapy is not a panacea for “all and every”
Volume Number
5i 3
SELECTED
531
ABSTRACTS
menopause symptom, for it is a fact that many women do not exhibit strictly menopausal symptoms-and therefore do not need hormone treatment simply because they are passing through or have passed the climacteric, often many years previously. In conclusion, the author emphasizes that just because a patient is approaching or actually in the midst of the menopause, organotherapy is not necessarily indicated; that the most reliable method of administration is implantation under the skin of e&radio1 of one of the synthetic estrogens. This method is contraindicated, however, if the patient is still menstruating or has only recently ceased; that hypodermic administration is indicated where and that oral administration is less satisfactory rapid and intensified effect is desired; because of the fact that it is always questionable just how much absorption of the active Ointments containing a high concentration of principle is obtained through this route. synthetic estrogens are now available and, for certain of the dermatoses, this form of therapy HARVEY B. MATTHEWS. may be adequate.
Menstruation, Culiner,
A. : The Relation $ Gynaec. Brit. Emp.
of Theta-Cells 52: 545, 1945.
Dysmenorrhea, to Disturbances
etc. of the
Menstrual
Cycle,
J. Obst.
In a previous study it was shown that the baboon, when the theca cells surrounding the ovarian follicles proliferate or luteinize so extensively as to be visible to the naked eye as yellowish plaques or masses, there is often disturbance of the menstrual cycle. There has been much speculation as the endocrine function of the theca cells, especially in relation The author has made a study of the ovaries and uteri obtained at to theca-cell tumors. operation on women with excessive bleeding or other uterine evidence of endocrine disorder. Many of these patients were in the fourth and fifth decades of life, and had previously had normal cycles and pregnancies. Serial sections of the ovaries were examined. As the ovaries are removed as a rule only for some gynecologic complaint, it is difficult to establish the incidence of theta lutein cells other than those related to corpora lutea in the normal human ovary. In the author’s series, luteinized theca-cells were found more frequently than was anticipated, but their extent and distribution was not closely related to the severity of the menstrual disorder. The author proposes the following classification of theta-cell proliferations on the basis of their relation to various types of atresia. Group I, corpus theeale luteum, in which the original form of the follicle is retained; in one subgroup (a) granulosa cells may be absent or degenerating; in another subgroup (b) granulosa cells are luteinized. Group II, corpus thecale luteum fibrosum, in which granulosa cells are not present, absorption of liquor folliculi has taken place, connective tissue cells fill the cavity and may be surrounded by a hyaline ring; luteinized theta cells are external to this ring. Group III, corpus thecale luteum candicans, in which lutein reactions occur around a collapsed Group IV, corpus thecale luteum hyalinum, in which there is a lutein corpus atreticum. reaction around follicles that have collapse with hyaline tissue invading the cavity. Group V, corpus the&e luteum restiforme, in which a lutein reaction occurs around primordial or small maturing follicles. All these types of theea-cell proliferation with luteinization have been observed in the author’s material except Group V, which, however, is theoretically posIn this material a wide range of endometrial reactions and clinical disturbances was sible. observed, but those could not be correlated with the type of theca-cell luteinization observed in the ovary. In a few cases, normal endometria were found, although luteinized theta-cells were present in the ovaries, and there were menstrual disturbances. From these observations, the author concludes that theta-cell proliferation may occur as part of the process of maturation of the Graafian follicle. Luteinization of theea-cells around atretie follicles may be without clinical significance in ovulatory cycles, but in the presence of extensive thecal luteinization with follicular atresia, disturbances of menstrual rhythm and abnormal bleeding may occur. From the character of the uterine reactions found in association with proliferation of theca-cells, neither estrogenic nor progesteronic action oan be ‘definitely attributed to them. It is possible that they are responsible for a third