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The menopausal syndrome
and A
rtment of Revi
Selected Abstracts Vaginal Infections Perez, l&me1 the Treatment
Luie, Arenas, Normando, and Blm~d, of Vaglnsl
Trichomoniasis,
Oscar: Our EZI@eriwe in
An. Inst. de Mat. y Asist. Sot. 2:
63, 1940.
Manuel Luis Perez, Normando Arenas and Oscar Blanehard review the m&hods of treatment in general use for trichomonas vaginalis vaginitis. They found the infection in 32 per cent of nonpregnant women, and in 50 to 70 per cent of pregnant women. Of all the pentavalent arsenieals used the most successful was p-oxy-acetylamino-phenylarseaic acid with kaolin as a vehicle. The instillation of 2 Gm. of the drug is preceded by vaginal application of a solution of I per cent pi&c acid. Good results were obtained in 150 patients. There were no recurrences. The authors also used silver picrate, 0.5 Gm. to 3 Gm. of kaolin, to which they added suppositories of silver picrate during the first week. The treatments were repeated every five to seven days and most patients were cured after from four to six applications. J. P. GREENEILL.
Brady, Leo, and Reid, Ruger D.: The Tmtnwnt of TrichomomeVaginaue Vaginttis With Ltibacillu~, Ann. Surg. 116: 840,1942. The authors present a method in the treatment of a very common ailment. They do not feel that the discharge of trichomonas vaginitis is typical to any degree, but it can simulate any other type of vaginal discharge. Failures in diagnosis may be attributed to the fact that sometimes the condition is overlooked and, secondly, that a previous bimanual examination with some lubricant inae. tivates the protozoan. Another failure in diagnosis may be attributed to the preliminary douche before examination. It is the opinion of the authors that not only is acid therapy necessary, but that, lactobacilli are also essential. A method was worked out whereby the authors inoculated sterile skimmed milk with lactobacillus bulgaricus and mixed it with sugar and milk sugar in such a manner as to form tablets. These tablets are then inserted into the vagina. The authors treated 50 cases in such a manner from 3 to 6 weeks and longer when necessary, with recurrences in only six cases. The relief is rather prompt. The importance of treatment for a few days each month around the menstrual time is stressed. WILLIAM BERMAN.
Menopause Bennett, Henry Ct., Jr., and TeLinde, Richard W.: The Mempauesl SM, J. A. M. A. 118: 1341, 1942. The authors describe their method of treatment of the menopause symptoms with the use of pure orystalline estrogen converted into pellets by compression of the substance in drilled machine ground steel plates. The number of implantations number from one to five and the average total weight of estrogen in each implant&ion was 40 milligrams. Ninety-three and four-tenths per cent coneidgwd Improvement usually began within two weeks the above treatment sati&actory. 277
278
AMERICAN
JOURNAL
OF
OWTETRICS
AXD
following implantation and lasted an average of 16.2 of toxic or systemic reaction. One case of abnormal tered. The method compares favorably only with bestrol pellets subcutaneously, except that with the more marked.
GYNECOLOGY
weeks. There were no signs uterine bleeding was encounthat of the injection of stillatter, the side reactions are
Another group of patients with theelin crystals in aqueous suspension istered hypodermically in total doses of 5 to 25 milligrams and satisfactory ical results were obtained in only 59.3 per cent of twenty-seven patients. natural estrogens given three times daily by mouth produced satisfactory in only 46 per cent of the cases.
adminclinOral results
Patients in the acute phase of the menopause respond better than those with prolonged histories. Surgical castrates responded better to pellet implantation than either the irradiated or the physiologic group. In regards to the vaginal smear, it was found that symptomatic relief preceded any change in the vaginal smear. There was no evidence to indicate that the estrone pellets were responsible for bleeding in this group. No evidence of benign endometrial proliferation was noted when pellets of estrone were used, but this was noted when the diethylstilbestrol pellets were used. There is some evidence to indicate that estrone is the weakest growth stimulator of the various estrogens. WILLIAM BERMAN.
Freed, S. C., W&in, W. M., and Greenhill, J. P.: The Oral Effectiveness of E&one Sulfate (Conjugated Estrogens-Equine) in Women, 5. Clin. Endocrinol. 3: 89, 1943. Estrone sulfate (premarin) is a naturally occurring estrogen in the urine OF pregnant mares. According to laboratory evidence, it is several times more potent than free estrone by mouth when administered to spayed rats. Administered to 152 women in dosages of 1.25 mg., 0.81 mg., and 0.4 mg., three times daily, it was found through therapeutic standardization according to subjective response to be satisfactorily effective in relieving symptoms of the menopause. Optimal results were obtained with the higher dosage, while the lower dosage generally The results obtained were generally superior resulted in the relief of symptoms. to those obtained in comparison with 118 women who received daily 0.5 mg. and 1.0 mg. of diethylstilbestrol orally. CLAUDE J. EHRENBERG.
Glass, 5, V., and Rosenblub, Cfordon: Therapy of the Menopause. Superiority of Conjugated Estrogens-Equine Over Diethylstilbestrol, J. Clin. Endocrinol. 3: 95, 1943. Previous to the introduction of sodium estrone sulfate (premarin) climacteric patients were treated orally with estriol glucuronidate (emmenin) and diethylstilbestrol. Introductory treatment in the severe cases with parenteral estrone or estradiol was frequent. In a preliminary study, eighty patients were administered sodium estrone sulfate with supplementary doses of diethylstilbestrol. The latter drug was soon found to be unnecessary for complete symptomatic relief. The present report is based on the treatment o.f seventy-one menopausal patients with sodium estrone sulfate alone. Initial dosages of 2.5 mg. to 3.75 mg. daily which were gradually reduced to as low as 1.25 mg. three times weekly effected good results in 82 per cent of the eases, fair results in 10 per cent, and poor results in 8 per cent of the patients. Questionable complications were noted in two eases. Sodium estrone sulfate is safe, effective, and orally active therapy for the relief of clim$cteric symptoms. CLAUDE J. EHRENBERG.
rtment of Revi
Selected Abstracts Vaginal Infections Perez, l&me1 the Treatment
Luie, Arenas, Normando, and Blm~d, of Vaglnsl
Trichomoniasis,
Oscar: Our EZI@eriwe in
An. Inst. de Mat. y Asist. Sot. 2:
63, 1940.
Manuel Luis Perez, Normando Arenas and Oscar Blanehard review the m&hods of treatment in general use for trichomonas vaginalis vaginitis. They found the infection in 32 per cent of nonpregnant women, and in 50 to 70 per cent of pregnant women. Of all the pentavalent arsenieals used the most successful was p-oxy-acetylamino-phenylarseaic acid with kaolin as a vehicle. The instillation of 2 Gm. of the drug is preceded by vaginal application of a solution of I per cent pi&c acid. Good results were obtained in 150 patients. There were no recurrences. The authors also used silver picrate, 0.5 Gm. to 3 Gm. of kaolin, to which they added suppositories of silver picrate during the first week. The treatments were repeated every five to seven days and most patients were cured after from four to six applications. J. P. GREENEILL.
Brady, Leo, and Reid, Ruger D.: The Tmtnwnt of TrichomomeVaginaue Vaginttis With Ltibacillu~, Ann. Surg. 116: 840,1942. The authors present a method in the treatment of a very common ailment. They do not feel that the discharge of trichomonas vaginitis is typical to any degree, but it can simulate any other type of vaginal discharge. Failures in diagnosis may be attributed to the fact that sometimes the condition is overlooked and, secondly, that a previous bimanual examination with some lubricant inae. tivates the protozoan. Another failure in diagnosis may be attributed to the preliminary douche before examination. It is the opinion of the authors that not only is acid therapy necessary, but that, lactobacilli are also essential. A method was worked out whereby the authors inoculated sterile skimmed milk with lactobacillus bulgaricus and mixed it with sugar and milk sugar in such a manner as to form tablets. These tablets are then inserted into the vagina. The authors treated 50 cases in such a manner from 3 to 6 weeks and longer when necessary, with recurrences in only six cases. The relief is rather prompt. The importance of treatment for a few days each month around the menstrual time is stressed. WILLIAM BERMAN.
Menopause Bennett, Henry Ct., Jr., and TeLinde, Richard W.: The Mempauesl SM, J. A. M. A. 118: 1341, 1942. The authors describe their method of treatment of the menopause symptoms with the use of pure orystalline estrogen converted into pellets by compression of the substance in drilled machine ground steel plates. The number of implantations number from one to five and the average total weight of estrogen in each implant&ion was 40 milligrams. Ninety-three and four-tenths per cent coneidgwd Improvement usually began within two weeks the above treatment sati&actory. 277
278
AMERICAN
JOURNAL
OF
OWTETRICS
AXD
following implantation and lasted an average of 16.2 of toxic or systemic reaction. One case of abnormal tered. The method compares favorably only with bestrol pellets subcutaneously, except that with the more marked.
GYNECOLOGY
weeks. There were no signs uterine bleeding was encounthat of the injection of stillatter, the side reactions are
Another group of patients with theelin crystals in aqueous suspension istered hypodermically in total doses of 5 to 25 milligrams and satisfactory ical results were obtained in only 59.3 per cent of twenty-seven patients. natural estrogens given three times daily by mouth produced satisfactory in only 46 per cent of the cases.
adminclinOral results
Patients in the acute phase of the menopause respond better than those with prolonged histories. Surgical castrates responded better to pellet implantation than either the irradiated or the physiologic group. In regards to the vaginal smear, it was found that symptomatic relief preceded any change in the vaginal smear. There was no evidence to indicate that the estrone pellets were responsible for bleeding in this group. No evidence of benign endometrial proliferation was noted when pellets of estrone were used, but this was noted when the diethylstilbestrol pellets were used. There is some evidence to indicate that estrone is the weakest growth stimulator of the various estrogens. WILLIAM BERMAN.
Freed, S. C., W&in, W. M., and Greenhill, J. P.: The Oral Effectiveness of E&one Sulfate (Conjugated Estrogens-Equine) in Women, 5. Clin. Endocrinol. 3: 89, 1943. Estrone sulfate (premarin) is a naturally occurring estrogen in the urine OF pregnant mares. According to laboratory evidence, it is several times more potent than free estrone by mouth when administered to spayed rats. Administered to 152 women in dosages of 1.25 mg., 0.81 mg., and 0.4 mg., three times daily, it was found through therapeutic standardization according to subjective response to be satisfactorily effective in relieving symptoms of the menopause. Optimal results were obtained with the higher dosage, while the lower dosage generally The results obtained were generally superior resulted in the relief of symptoms. to those obtained in comparison with 118 women who received daily 0.5 mg. and 1.0 mg. of diethylstilbestrol orally. CLAUDE J. EHRENBERG.
Glass, 5, V., and Rosenblub, Cfordon: Therapy of the Menopause. Superiority of Conjugated Estrogens-Equine Over Diethylstilbestrol, J. Clin. Endocrinol. 3: 95, 1943. Previous to the introduction of sodium estrone sulfate (premarin) climacteric patients were treated orally with estriol glucuronidate (emmenin) and diethylstilbestrol. Introductory treatment in the severe cases with parenteral estrone or estradiol was frequent. In a preliminary study, eighty patients were administered sodium estrone sulfate with supplementary doses of diethylstilbestrol. The latter drug was soon found to be unnecessary for complete symptomatic relief. The present report is based on the treatment o.f seventy-one menopausal patients with sodium estrone sulfate alone. Initial dosages of 2.5 mg. to 3.75 mg. daily which were gradually reduced to as low as 1.25 mg. three times weekly effected good results in 82 per cent of the eases, fair results in 10 per cent, and poor results in 8 per cent of the patients. Questionable complications were noted in two eases. Sodium estrone sulfate is safe, effective, and orally active therapy for the relief of clim$cteric symptoms. CLAUDE J. EHRENBERG.