Gardner M. Riley

Polycystic ovarian disease

Abstract Forty patients with a diagnosis of polycystic ovarian disease (Stein-Leventhal syndrome) are presented. All were subjected to ovarian wedge resections which resulted in ovulatory cycles in 36. Thirty-seven pregnancies occurred in 21 patients. All had normal excretory rates for estrogen and gonadotropin. 17-Ketosteroid levels were normal or slightly elevated. In those cases tested, pregnanetriol values were all within normal limits. Pregnanediol levels were comparable to those found during the follicular phase of a normal menstrual cycle. In 2 patients LH excretion was comparable to that found in three normal patients during the pre- and postovulatory phases. A third patient had slightly greater LH levels. Cystic ovaries were produced experimentally in rats by several methods which permitted continuous exposure of the ovaries to FSH without sufficient LH for ovulation and luteinization. Analysis of these clinical and experimental data provides a possible explanation for the production of polycystic ovaries and the usually favorable response to ovarian wedge resections. These observations suggest that the Stein-Leventhal syndrome is but a part or phase of the over-all problem of anovulatory ovarian function.Forty patients with a diagnosis of polycystic ovarian disease (Stein-Leventhal syndrome) are presented. All were subjected to ovarian wedge resections which resulted in ovulatory cycles in 36. Thirty-seven pregnancies occurred in 21 patients. All had normal excretory rates for estrogen and gonadotropin. 17-Ketosteroid levels were normal or slightly elevated. In those cases tested, pregnanetriol values were all within normal limits. Pregnanediol levels were comparable to those found during the follicular phase of a normal menstrual cycle. In 2 patients LH excretion was comparable to that found in three normal patients during the pre- and postovulatory phases. A third patient had slightly greater LH levels. Cystic ovaries were produced experimentally in rats by several methods which permitted continuous exposure of the ovaries to FSH without sufficient LH for ovulation and luteinization. Analysis of these clinical and experimental data provides a possible explanation for the production of polycystic ovaries and the usually favorable response to ovarian wedge resections. These observations suggest that the Stein-Leventhal syndrome is but a part or phase of the over-all problem of anovulatory ovarian function.

Use of Serial Vaginal Smears in Detecting Time of Ovulation

This evaluation of the vaginal-smear method as a means of detecting time of ovulation is based on examination of 452 series of smears from 300 patients. Basal temperature curves were used for comparison with the serial smears in 126 cases. Collection is performed by the patients at approximately 24-hour intervals. Using a cotton applicator tip the women sampled their own vaginal cells and rolled the sample over a microscope slide and then returned the entire series to the physician for air-dried fixing and staining. The smears were stained by the method of Papanicolaou. A representative series of smears from 1 patient is published here. An ovulatory smear was one demonstrating the most advanced stage of follicular phase of the cycle and was characterized by clarity of background maximal concentration of conified cells tendency for cells to remain separated and leukopenia. When the smear method was compared for accuracy to the basal body temperature method close correlation was found. The ovulatory smear was obtained on the first day of thermal rise in 28.6% and on the day preceding thermal rise in 39.7%. A regression line was drawn which showed the relationship between day of ovulation as detected by the vaginal smear method and the length of cycle and the equation of this line indicates that for every 1 day that is added to the cycle length the ovulation day advances only .78 of a day. Thus there is a tendency for the length of the secretory phase to vary directly with the length of the menstrual cycle; but despite this statistical association ovulation is very hard to pin down.

VIRAL STUDIES OF THE FEMALE REPRODUCTIVE TRACT.

Abstract Standard cell culture techniques were employed in an attempt to isolate viruses from gynecological material. Several different cell lines were used in the tissue culture system and many different culture conditions were employed. One hundred and eighty specimens were collected from normal individuals and those with a variety of gynecological conditions. The only viral agent isolated was identified as herpes simplex. The protozoan T. vaginalis was isolated and grown in association with cultured cells. Three continuous cell lines were isolated from cultures inoculated with clinical specimens. The hypothesis that the female reproductive tract harbors a number of viruses is discussed.

Irradiation sensitivity of cervix cancer: Response of cultured cervix cancer cells to irradiation☆☆☆

Abstract 1. 1. A new in vitro approach to the problem of predicting irradiation sensitivity of female genital tumors is described. 2. 2. The results indicate that some carcinomas are relatively resistant to irradiation, whereas others are readily destroyed. Although the results appear promising, it is premature to assume that irradiation sensitivity of cultured cancer cells in vitro truly reflects the tumors response in vivo.

Detection of characteristic differences in the irradiation sensitivity of four human cancer cell strains.

Monolayers of four human cancer cell strains were exposed to various doses of x radiation during different phases of their growth cycles. The effects as measured by changes in cell number were dependent on the radiation dose. The dose-response curve of each strain varied significantly when radiation was administered during different stages of the population cycle. With three strains, HeLa, RP Ca Vu I, and RP Ca Ov I, the cells at the beginning of the logarithmic growth phase were more sensitive to radiation than cells entering the negative growth acceleration phase. With the other strain, RP Ca Cx I, the reverse was true. Highly significant differences in the radiation sensitivity of the four cell lines were detected when radiation was administered during the fourth culture day, a period when the cells were entering the phase of negative growth acceleration. The characteristic differences appear to be consistent with the generally accepted radiotherapeutic susceptibility of the tumors from which the cell lines were originally derived. (auth)

The application of a silver carbonate stain for the diagnosis of uterine cancer by the vaginal smear method

Abstract 1.1. The silver carbonate staining method of Hortega was modified for staining the cellular elements of vaginal smears. The details of the procedure are described. 2.2. The affinity of chromatin material for the silver stain, together with the usual hyperchromatic character of atypical cells, combine to make this a useful stain in the diagnosis of uterine cancer by the vaginal smear method. 3.3. The cytoplasmic and nuclear characteristics of cells impregnated with silver carbonate are described and several noteworthy advantages of the technique over other conventional differential stains are listed.

Clinical evaluation of the silver carbonate vaginal smear method in the diagnosis of uterine cancer.

Abstract 1. 1. A summary of the technical details of the silver carbonate staining method for vaginal smears is presented and the qualities of the stain are illustrated by photomicrographs of normal, suspicious, and malignant cells. 2. 2. During three successive years (1947–1950), three different examiners evaluated smears from a total of 2,008 gynecological patients whose history or clinical findings were suspicious for carcinoma of the uterus. 3. 3. The total number of carcinoma cases in the series was 120. Of this number, 98 cases were correctly diagnosed, leaving a total of 22 (18 per cent) undetected carcinomas. In the series of 1,888 patients without pathologically diagnosed carcinoma, 22 false positive diagnoses (1.2 per cent) were submitted. The total percentage error based on the total number of cases studied was 2.2 per cent. 4. 4. It is pointed out that the accuracy attained with this procedure compares favorably with that reported by others using conventional polychrome stains. Although additional experience with the cytological method and especially with the characteristics of silver-impregnated cells may be expected to result in fewer errors, improvements in methods for obtaining the cell samplings, especially from the endometrium, will tend to reduce the number of missed carcinomas. 5. 5. The experiences of the investigators with the silver technique during this trial period suggest that it may have certain practical advantages over polychrome procedures. Among these advantages are simplicity, rapidity, ease of examination, and the facility with which nuclear aberrations are recognized. These qualities, together with the observed accuracy, should prove of value in the application of cytological methods for the detection of carcinoma.

Evaluation of ovarian function.

Evaluation of ovarian function has assumed importance in most medical disciplines. Nevertheless, current knowledge of the extent to which ovarian function is implicated in health and disease probably is only superficial. Ovarian steroids are useful in treatment of disorders not related directly to sex function and reproduction. Clinical findings may provide useful clues to ovarian dysfunction. Ovarian activity may be assessed by basal body temperature records, vaginal smears, progesterone withdrawal bleeding, premenstrual endometrial biopsies, cervical mucus fern tests, and endocrine assays. Measurement of gonadotropins, 17-ketosteroids, pregnanediol and thyroid function may be useful in addition to measurement of estrogen and pregnanediol. Specific methods are mentioned. Sex chromatin patterns, while useful in determining genetic sex, are of limited value as a reflection of ovarian function because of the paradoxical situations described.