David L. Barclay

Luteoma of pregnancy

Abstract 1. The luteoma of pregnancy is a benign tumor of lutein-like cells occurring most often in patients of high parity and usually discovered at laparotomy at or near term. 2. Twelve examples of this lesion are presented of which 6 were multinodular and 4 of these were bilateral. 3. The pregnancy luteoma has characteristic microscopic features including acidophilic granular cytoplasm with sparse lipid, and a distinctive pattern of reticulum fibers. 4. The tumors most likely are derived from theca-lutein cells of atretic follicles stimulated by chorionic gonadotropin, although some may be derived from stroma-lutein cells. In one instance, the pregnancy luteoma originated in the theca interna of a corpus luteum of pregnancy. 5. There is evidence that the lesion spontaneously regresses following the drop in chorionic gonadotropin after delivery.

The influence of inferior vena cava compression on the level of spinal anesthesia

Abstract It is well known that the pregnant patient requires less anesthetic agent for induction of spinal anesthesia than does the nonpregnant patient. The purpose of this study was to demonstrate that compression of the inferior vena cava by the pregnant uterus or by an abdominal binder causes engorgement of the vertebral venous system, which in turn decreases the capacity of the spinal subarachnoid space for spinal fluid. Therefore, a smaller quantity of anesthetic agent would be required to induce spinal anesthesia. A spinal anesthetic was administered under standard conditions to 20 nonpregnant patients, 15 pregnant patients at term, and 15 nonpregnant patients in whom the inferior vena cava pressure was artificially increased to approximately 250 mm. of water. The results indicated that an increase in inferior vena cava pressure causes a decreased requirement for anesthetic agent for the induction of spinal anesthesia.

Accidental trauma complicating pregnancy and delivery.

Abstract 1. 1. Fifty-three instances of trauma in pregnancy and 23 of preconceptional trauma have been presented. 2. 2. There were 30 auto vehicle accidents, 5 penetrating wounds of the uterus (3 gunshot and 2 knife), 13 falls, and 3 severe beatings in pregnancy. 3. 3. The effect of pelvic fracture on pregnancy and delivery was reviewed. Thirteen pelvic fractures occurred during pregnancy and 22 prior to pregnancy. 4. 4. Six penetrating wounds of the gravid uterus were studied. One gunshot wound of the uterus which occurred prior to pregnancy was reported. 5. 5. Blunt abdominal trauma produced rupture of abdominal viscera in 5 women and placental separation in 2. No ruptured uteri were observed from blunt trauma. 6. 6. Fetal trauma was observed in 5 patients, and placental injury in 3. 7. 7. There were 2 maternal and 12 fetal deaths. 8. 8. Reference is given to the legal aspects of fetal injury in utero.

Human luteal function following hysterectomy as assessed by plasma progestin

Abstract To assess the effect of hysterectomy on the duration of functionality of the corpus luteum, 5 patients were scheduled for vaginal hysterectomy between cycle Days 18 and 22. Plasma progestin and luteinizing hormone concentrations were determined in samples obtained during the follicular phase, prior to and 48 hours after operation, and then at weekly intervals for at least 13 weeks. During the operative cycle, progestin values were elevated for a minimum of from 14 to 20 days. Thereafter, plasma progestin concentration indicated persistence of normal cyclic ovarian function. The timing and occurrence of elevated LH levels supported the conclusion that, in contrast to findings in a number of other species, normal ovarian cyclicity is maintained following hysterectomy in human beings.

Ectopic pregnancy: A seventeen-year review☆☆☆★

Abstract 1. 1. The diagnosis and management of 699 consecutive cases of tubal or interstitial pregnancy during a 17 year period has been reviewed. 2. 2. Previous pelvic infection or operation appear to be predisposing factors. 3. 3. The use of culdocentesis as an out-patient procedure was emphasized as being the single most important diagnostic procedure. 4. 4. Salpingectomy was the most commonly employed operative procedure, although the incidence of associated hysterectomy has increased to 42.5 per cent during the last 5 years. 5. 5. There was one death in the entire series, giving a mortality rate of 0.14 per cent during a 17 year period.

Luteoma of pregnancy: Steroidogenic and morphologic considerations

Abstract Steroid hormone content and steroid synthesis in vitro were studied in a clinically and morphologically typical luteoma of pregnancy. The only Δ 4 -3-ketosteroid present was tentatively identified by paper and thin-layer chromatography as Δ 4 -androstene-3,17-dione. Net synthesis (μg) of this androgen was augmented in vitro by HCG. No radioactive steroid formation from acetate-1- 14 C could be established after analysis by reverse isotope dilution. The biochemical and histologic data suggest that the luteoma of pregnancy originates from the ovarian stroma. The augmentation of steroidogenesis by HCG in vitro in this study and the clinical observation of postpartum regression in other studies are compatible with the concept that the placental gonadotropin plays some role in development and maintenance of this specific ovarian lesion.

Intraepithelial cancer of the vulva

Abstract Establishment of a vulvar disease clinic on our service has dramatically increased the diagnostic acumen of the resident staff. In addition during the last 5 years 34 per cent of vulvar cancers diagnosed have been in the intraepithelial stage. More intensive and frequent use of biopsy of the vulva is advocated. Extensive vulvectomy is sufficient for the therapy of intraepithelial cancer. Lymphadenectomy is not necessary for the cure of noninvasive cancer. Eponyms have no place in predicating therapy, as all types of intraepithelial cancer have invasive potential.

CESAREAN HYSTERECTOMY. THIRTY YEARSʼ EXPERIENCE

From 1938 through 1967, 866 cesarean hysterectomies were performed by a group of supervised resident physicians. During early years, some of the operations were of the subtotal type, but none has been performed since 1951. Of the 866 operations, 177 were of emergency nature because of uncontrollable hemorrhage. More than 60% of the 689 elective cesarean hysterectomies were performed because of a defective uterine scar; sterilization was the acknowledged or implied reason in only 88 patients. There were 9 maternal deaths, 2 following elective and 7 after emergency cesarean hysterectomy; only 2 of the 9 occurred after 1952. No complications eventuated in 90% of the elective operations and in nearly 50% of the emergency operations. Urinary tract infection was the most common postoperative complication, occurring in 23%. The authors data indicate that cesarean hysterectomy is safe and useful.

Virilizing luteoma of pregnancy: Specific sterol and steroid hormone content

Abstract The specific sterol and steroid hormone content of a virilizing luteoma of pregnancy has been studied. The androgens, 4-androstene-3,17-dione, DHA, and testosterone, were the major free steroid hormones present in the tumor. Lanosterol, 4,4-dimethyl-8-cholesten-3β-ol, 4α-methyl-7-cholesten-3β-ol, and 7-cholesten-3β-ol were tentatively identified in the luteoma and represent the first identification of these sterols in human gonadal tissue. Three plant sterols, campesterol, stigmasterol, and β-sitosterol were also tentatively identified in trace amounts.