Gynecology

Gynecology

Bourne, Aleck: Endocrines in Gynaecology, Brit. M. J. 4489: i9, 194;. Kourne reviews the progress in this ficltl oi’ medicine 8inw its itlitint...

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Bourne, Aleck:

Endocrines

in Gynaecology,

Brit.

M. J. 4489:

i9,

194;.

Kourne reviews the progress in this ficltl oi’ medicine 8inw its itlitint ion by Stwli:tnl :;l,i. i’apanieolaou in 1917. The present-day concept of the physiology of the various horruoir~~~ is fir::t discussed. He postulates the existence of receptor substances in the vaginal II~UUW:~. entlometrium, and other tissues in the genital tract which are able to react with the estrogellil, molecule and, by chemical or other union, perform a spccifie function. The absence of su1.11 substruce in other tissues of the body is obvious. The author stresses the fallacious conclri sions with reference to human physiology that are often drawn from animal experimentation. In approaching the problem of therapeutics, he stresses the lac~k of exact knomlelly~, as to whether vve are dealing with a deficiency, excess, or disordered rhythm in the protlur, lion of the hormones concerned. In the evaluation of therapeutic response hc suggests (!i viding the sex-organ disabilities into those which are functional and those which are ohjecti~~~ or organic. In the latter group, t,he only one in which we can be certain of success is m suppression of lactation. The results of treatmeut in pelvic Iiypoplasia with amenorrhea ant1 sterility, atrophy of vulvovagina, leucoplakia, and metropathia have been disappointing. I,ikr wise the treatment of functional disorders such as dysmenorrhea and repeated abortion gives disappointing results. In summary, the disappointments in therapy are attributed to plunging too quickly fro111 tlrr c~udocrinology of animals to its application in clinical medicine. Another difficulty is tlir~ complexity of biochemical assay in various organic fluids from qualitative and quantitative points of view mu1 their impractical aspects in practice. R. G. DorTolAzi.

Endometriosis McGuff, Paul, Dockerty, Malcolm B., Waugh, John M., and Randall, Lawrence M.: Endometriosis as a Cause of Intestinal Obstruction, Surg., Gynec. & Obst. March, 1948. The paper presents an analytical study of sixteen cases of intestinal obstruction cause11 by endometriosis. The usual symptoms of lower intestinal obstruction, associated with acquired dysmenorrhea, sterility, and pelvic pain should bring the possibility of thix con dition to mind. The treatment is relief of the obstruction, usually by resection. The que8tion of removal of the pelvic organs will depend on the extent of the endomet,rial implants. If there is hope of future pregnancy, bilateral oophorectomy should be avoided. A plea is matlc for the more frequent use of frozen sections to prevent confusing this lesion with carcinoma. LOUIS IN. HELLMAP;.

Gynecology Frank,

Robert 361,

T.:

Dyspareunia:

A Problem

for the General Practitioner,

J. A. M. A. 136:

1948.

The author reviews his clinical experiences over a period of year8 in the treatment of dyspareunia. These cases represented 1.5 per cent of his gynecologic practice over the same number of years. Dyspareunia that developed with marriage was primary and when f hc onset occurred later it was termed secondary and treated accordingly. Tt was interesting to note that of t,he 349 patients reviewed, normal pelves were noted in 63 patients. Fifty-five per cent of these women showed neuroses and psychoneuroses, in sharp contrast to the per centage of the total figure (349) which was only 25 per cent. The hu8band problem predominated in 36 cages. In primary and secondary dpspareunia, local therapy combined witl; enlightenment and orientation proved effective. WIL~,IA&~ BERE~~AK.

Norment,

W. B.:

A Method

of Study of the Uterine

Canal, South.

Surgeon,

Dec.!

1917.

Direct visualization of the uterine cavity and x-ray hysterogram are advocated for the study of gynecologic patients. For hysterogram study, and organic iodine in alcohol by Rayopake is recommended in preference to oil. Direct visualization of the uterine cavity is obtained by the insertion of a translucent and transparent bag over a pia8tie cannula which is inserted into the uterine cavitv.