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The clinical manifestations of glandular hyperplasia of the endometrium
162
AMERICAN
JOUKKAL
OF
OBSTETRICS
ASD
GYNECOLOGY
it is possible in cases in which mixell effects arc obtained to determine by means of histologic study which of the hormones is prcadominant. The histologic appearances of the rndometrium obtained from cases of Swiss cheese hyperplasia are very similar to t,hose foun11 in animals which have been injected with extracts of placenta. Material obtained from the follicle cysts of human cases of hyperplasia when injected into mice and rats, produced estrus. The changes in the uterus of each case were similar in many respects to those found in the uterus of the experimental animals receiving the fluid from that case. WM. C. HENSIX
Adler, E.: The Clinical Manifestations of Glandular Hyperplasia metrium, Monatschr. f. Geburtsh. u. Gyniik. 90: 340, 1932.
of the Endo-
The etiology of granular hyperplasia of the endometrium is not clear. In most cases, there are enlarged ovaries with one or more follicle cysts and in the majority of cases, no corpus luteum is present. Bdler studied 67 cases of endometrial hyperplasia from the clinical point of view. Most of the patients were more than thirty-six years of age (68.7 per cent). The next most frequent group was between fifteen and twentyfive years. The most prominent symptom was uterine bleeding and this varied considerably in type. In the majority of cases the bleeding consisted of an increased flow during the menses but the intervals between the periods were prolonged. In most cases the uterus was enlarged and this was observed in the very young patients as well as in the older ones. Almost all of the patients were nulliparas. The uterus was generally softened and the cervical canal offered no resistance to mechanical dilatation. During the preclimacteric period and the menopause, the enlarged uterus was usually associated with fibroids. The latter showed a special tendency to increased growth during the menopause. Zondek has shown that at the onset of the menopause there is an increased amount of folliculin in the blood and urine. It is therefore conceivable that the hyperplasia in the climacteric map be due to an excess of the proliferation hormone. During the reproductive years there is a special tendency toward hyperplasia among nulliparas; for of the 17 women between fifteen and thirty-fire years of age, 14 had never borne children. On the other hand, among the 43 women who had hppcrplasia during the preclimactoric and the climacteric only 5 were nulliparas. The treatment for women over fort)years of age is simple. After curettement is roentgen-ray therapy should be employed. In performed and the diagnosis made, wom(xn past the menopause curettage alone usually suffices. In young women, a curettemerit is necessary for a diagnosis and it generally produces a temporary cure. However, the condition usually recurs. Hysterectomy is never necessary. .J. I’. GR~EN~II,~,.
Reinhart, 14:
413,
H. L., and Moore, R. A.: Tuberculous
Endometritis,
J. Lab.
62 Clin.
Med.
1929.
The incidence of tuberculosis of the uterus is not as common as is often assumed. Primary tuberculosis of the female genital tract is extremely rare, in fact the exact modus operandi of infection has never been proved. Most tuberculous infections of Infection is usually transmitted through the blood the genital tract are secondary. stream (metastatic) and the original lesion is most frequently in the lung or bronchial lymph nodes. Metastatic lymphatic infection to the genitals is rare. The uterus being an organ which is constantly contracting, the lymph flow through that organ is SO active that bacilli are not permitted to remain in one place long enough to develop a With menstruation the uterus performs a “physiologic curettage” by shedlesion. ding itself. This physiologic function together with the menstrual congestion prevents chronic infection with ordinary bacteria, and this same factor is probably operative in the case of tuberculosis.
AMERICAN
JOUKKAL
OF
OBSTETRICS
ASD
GYNECOLOGY
it is possible in cases in which mixell effects arc obtained to determine by means of histologic study which of the hormones is prcadominant. The histologic appearances of the rndometrium obtained from cases of Swiss cheese hyperplasia are very similar to t,hose foun11 in animals which have been injected with extracts of placenta. Material obtained from the follicle cysts of human cases of hyperplasia when injected into mice and rats, produced estrus. The changes in the uterus of each case were similar in many respects to those found in the uterus of the experimental animals receiving the fluid from that case. WM. C. HENSIX
Adler, E.: The Clinical Manifestations of Glandular Hyperplasia metrium, Monatschr. f. Geburtsh. u. Gyniik. 90: 340, 1932.
of the Endo-
The etiology of granular hyperplasia of the endometrium is not clear. In most cases, there are enlarged ovaries with one or more follicle cysts and in the majority of cases, no corpus luteum is present. Bdler studied 67 cases of endometrial hyperplasia from the clinical point of view. Most of the patients were more than thirty-six years of age (68.7 per cent). The next most frequent group was between fifteen and twentyfive years. The most prominent symptom was uterine bleeding and this varied considerably in type. In the majority of cases the bleeding consisted of an increased flow during the menses but the intervals between the periods were prolonged. In most cases the uterus was enlarged and this was observed in the very young patients as well as in the older ones. Almost all of the patients were nulliparas. The uterus was generally softened and the cervical canal offered no resistance to mechanical dilatation. During the preclimacteric period and the menopause, the enlarged uterus was usually associated with fibroids. The latter showed a special tendency to increased growth during the menopause. Zondek has shown that at the onset of the menopause there is an increased amount of folliculin in the blood and urine. It is therefore conceivable that the hyperplasia in the climacteric map be due to an excess of the proliferation hormone. During the reproductive years there is a special tendency toward hyperplasia among nulliparas; for of the 17 women between fifteen and thirty-fire years of age, 14 had never borne children. On the other hand, among the 43 women who had hppcrplasia during the preclimactoric and the climacteric only 5 were nulliparas. The treatment for women over fort)years of age is simple. After curettement is roentgen-ray therapy should be employed. In performed and the diagnosis made, wom(xn past the menopause curettage alone usually suffices. In young women, a curettemerit is necessary for a diagnosis and it generally produces a temporary cure. However, the condition usually recurs. Hysterectomy is never necessary. .J. I’. GR~EN~II,~,.
Reinhart, 14:
413,
H. L., and Moore, R. A.: Tuberculous
Endometritis,
J. Lab.
62 Clin.
Med.
1929.
The incidence of tuberculosis of the uterus is not as common as is often assumed. Primary tuberculosis of the female genital tract is extremely rare, in fact the exact modus operandi of infection has never been proved. Most tuberculous infections of Infection is usually transmitted through the blood the genital tract are secondary. stream (metastatic) and the original lesion is most frequently in the lung or bronchial lymph nodes. Metastatic lymphatic infection to the genitals is rare. The uterus being an organ which is constantly contracting, the lymph flow through that organ is SO active that bacilli are not permitted to remain in one place long enough to develop a With menstruation the uterus performs a “physiologic curettage” by shedlesion. ding itself. This physiologic function together with the menstrual congestion prevents chronic infection with ordinary bacteria, and this same factor is probably operative in the case of tuberculosis.