G.E. Seegar Jones

Double uterus as an etiological factor in repeated abortion: Indications for surgical repair

Abstract Approximately one of every four women with a double uterus will have some serious reproductive problem and no living children. In women with such reproductive difficulties, namely, premature labor or repeated abortion, surgical unification of the double uterus may be followed by term delivery of a living child, but only when adequate investigation of both husband and wife reveals no other cause for the difficulty. Surgical unification may also be useful in the rare case of unilateral hematometra.

Steroid 3β-ol dehydrogenase activity in human endocrine tissues

Abstract With histochemical methods, steroid 3β-ol dehydrogenase activity is readily demonstrable in the human corpus luteum, adrenal, and placenta but has been found in only one apparently normal testis. An analysis of tissues by gas-liquid phase chromatography has usually demonstrated some formation of Δ 4 -androstene-3, 17-dione, the expected steroid oxidation product in the presence of exogenous DPN. In the human gonads the highest enzyme activity appeared to be clearly associated with known instances of maximum progesterone production. The marked variation in activity noted in the cortex of human adrenal glands suggests this enzyme may be used as an indicator for certain physiologic activity.

The metabolism of progesterone in the hysterectomized woman

Abstract Progesterone has been injected into hysterectomized women and recovered, in part, in the urine as pregnanediol. The percentage recovered was the same as that observed for a normal woman in the follicular phase of the cycle who was injected with an equal amount of the hormone. Pregnanediol, in amounts comparable to those found in normal cyclic women, was recovered from the urine of hysterectomized women at a time when they were estimated to be in the luteal phase of the cycle. It is estimated that the hysterectomized woman is able to metabolize both exogenous and endogenous progesterone.

A survey of functional uterine bleeding with special reference to progesterogen therapy

Abstract 1.1. During the past seven years, approximately 700 cases of functional bleeding have been seen in the gynecologic out-patient department of the Johns Hopkins Hospital. During this same period, 104 young women with severe symptoms have been selected from the general dispensary for referral to the special functional bleeding clinic. Thus, only about one case in seven was severe enough symptomatically or in the proper age group to require conservative therapy other than curettage. 2.2. When 104 cases of functional uterine bleeding were classified according to the endometrial diagnosis of the original curettings, 66 per cent were hyperplastic, 16 per cent interval nonsecretory, 12 per cent secretory, and the remaining 6 per cent were chronic endometritis and atrophic types. 3.3. A total of 234 curettements was done on these 104 patients. Sixty-three per cent of the repeated curettages performed for a recurrence of symptoms showed no change in the endometrial pattern. Of the remaining 36 per cent of patients who showed a variation in pattern, none of the untreated varied from the nonsecretory type to secretory.The patients showing endometrial hyperplasia and other types of nonsecretory endometrium were clinically similar and on subsequent curettages showed the endometrial patterns to be mutually interchangeable. For this reason, no differentiation has been made between these groups in the evaluation of therapy. 4.4. Seventy-four of the 91 patients showing nonsecretory endometrium were considered suitable for cyclic progesterogen therapy in that they constituted a group of young women with severe symptoms which did not respond to other forms of treatment. In 72 cases, the bleeding symptoms were satisfactorily controlled. A patient with an ovarian neoplasm and another with gonorrheal cervicitis and an associated pelvic inflammatory disease failed to respond to therapy. Thirty-one patients had no recurrence of symptoms following the initial three-month cyclic course of medication. Sixteen of these thirty-one patients had no adjunctive therapy. Recurrences which occurred in forty patients were successfully treated again with progesterone. 5.5. Oral progeninolone has been as satisfactory as intramuscular progesterone in the present series, in approximately 90 per cent of the patients. 6.6. Estrogen has been used in conjunction with progesterone only in the two cases of bleeding associated with an atrophic type of endometrium. 7.7. There were thirteen cases showing secretory endometrium and originally considered to be truly functional in type. Of these, however, only four proved to have uncomplicated functional bleeding. These cases had a disturbance in the menstrual interval. In the other nine cases there were prolonged, profuse, but regular menses, although some of these had spotting during the menstrual interval. Six patients in this group showing secretory endometrium were treated with progesterone and none responded to therapy. It has been assumed, therefore, that although progesterogen therapy is excellent in functional bleeding associated with nonsecretory endometrium, it is unsatisfactory in those patients who have abnormal bleeding associated with secretory endometrial patterns.