Irving F. Stein

Results of bilateral ovarian wedge resection in 47 cases of sterility

A T FNE-YEAR intervals in the past two decades, we have reported our observations on patients in whom we diagnosed bilateral polycystic ovaries.l* 2l 3 We have described a syndrome characteristic of this lesion and adapted a surgical technique which has proved satisfactory. Since our first successful operation in 1929, we have operated upon seventy-five patients for this condition with increasingly encouraging results. In this report, we summarize the results of wedge resection of bot,h ovaries in those patients in the group who complained primarily of sterility. In the past, the prognosis in sterile matings has rested chiefly upon the results of tubal patency tests and the examination of the semen. Fundamental though these tests may be, it is our opinion that insufficient emphasis has been placed upon the reproductive role of the ovaries. More recently, tests for ovulation, such as endometrial biopsy, basal body temperatures, pregnandiol determinations, and daily vaginal smears have been carried out by some physicians to determine the occurrence and time of ovulation? We believe too little attention has been given to changes in the ovaries themselves, particularly in women who do not conform to the ovulatory pattern. One of the conditions encountered in patients complaining of sterility and amenorrhea, and one too frequently unrecognized, is bilateral polycystic ovaries. In this condition, ovulation occurs very rarely, at long intervals, or not at all, as shown by repeated endometrial biopsies and vaginal smears, basal temperature charts, and suggested by the history of sterility. The prognosis for fertility in these women grows progressively worse unless suitable positive measures are taken. The symptoms which prompt the patient to seek advice are, in the order of their frequency : 1, amenorrhea ; 2, sterility ; 3, hirsutism ; 4, pain (rarely) ; and 5, menometrorrhagia (occasionally). Underdeveloped breasts, acne, and/ or obesity are more often discovered by the physician than observed by the patient. Many of these women are psychically depressed. Bilateral polycystic ovaries are associated with a definite syndrome which we have described previously.3 In this condition, amenorrhea is usually secondary in character. After puberty, and for a period of a few years, there

Sperm Survival at Estimated Ovulation Time: Prognostic Significance

In a group of 25 infertile couples the wives were asked to report daily for vaginal smears for evaluation of timing of ovulation. Basal body temperature was also recorded. Artificial insemination was performed or coitus was recommended to take place during estimated time of ovulation. 150 examinations of cervical secretions were made daily for 7 days from 1 1/2 hours to 72 hours after insemination. Data on 1) amount and consistency of cervical mucus; 2) number of pus cells and spermatozoa and 3) grade of sperm motility were analyzed from standpoint of timing of ovulation; effect of drugs (stilbestrol sulfonamides and hyaluronidase) and; prognostic significance of sperm survival. Spermatozoa survived routinely in the cervical mucus at ovulation time from 1 1/2 to 72 hours post-insemination (average 22 hours; mode 24 hours). There was a direct relationship between increased quantity and diminished viscosity of cervical secretions and prolonged sperm survival. Survival time of spermatozoa in the mucus is improved by the administration of estrogens but not by hyaluronidase. Where cervicitis exists sulfonamides serve to increase sperm survival. In the absence of estrogen therapy sperm survival for 24 hours or more in the cervical mucus signals ovulation time. Nevertheless optimal sperm survival in cervical mucus does not guarantee pregnancy.

Sperm Survival at Estimated Ovulation Time: Comparative Morphology: Relative Male Infertility

Postcoital cervical mucus specimens were obtained from 45 couples and analyzed for sperm morphology. Sperm morphology was compared with analysis of semen previously obtained directly from male partners. Grade of motility was designated from grade 0 (no motility) to grade 4 (active forward progression). The sperms survived in the cervical mucus for as long as 58 hours around ovulation time. The surviving sperms exhibited comparable motility in the cervical mucus at ovulation time as was noted in the original sample. Morphologically the sperms surviving in cervical mucus were of superior quality compared to those obtained from the same male by friction or withdrawal. In 33 marriages given a guarded prognosis mainly based on the basis of substandard sperm conception eventually occurred giving an incidence rate of 17.1%. On the basis of these results the authors suggest that the Committee on Minimum Standards reconsider their established criteria for male sterility.

Further studies on trichomonas vaginalis (donné)

Abstract The cultures confirmed the findings of direct smear examinations although the relative number of the various organisms was affected by culturing. Doderlein bacillus grows very scantily, and the gram-positive nonhemolytic streptococcus cultures luxuriantly. No group of strict anaerobes was found, although the gram-positive streptococcus and the gram-negative bacillus grew readily under anaerobic as well as aerobic conditions. The only organisms found with any degree of consistency in all patients with Trichomonas vaginalis vaginitis were the Doderlein bacillus and the gram-positive nonhemolytic streptococcus. These organisms were likewise found in about the same proportions in all cases in which no Trichomonas vaginalis were found. The streptococcus, in agreement with the experience of Curtis, appeared in a diplococcic form in direct smear examination and was either oval or lancet-shaped. It formed chains when grown on artificial culture media. A number of streptococci isolated from our cultures were subcultured in sugar (lactose, mannite, salicin, and saccharose) and according to Holmans 9 classification, belonged to the following groups: Streptococcus ignavus, Streptococcus salivarius, and Streptococcus nonhemolyticus III. Other bacteria found less consistently in both groups were B. coli, a staphylococcus, B. mucosus, diphtheroids, a small gram-negative diplococcus (not gonococcus), a small gram-negative bacillus not of the typhoid-coli group, a thin gram-negative bacillus (Vibrio), a large gram-positive spore-bearer, and one large gram-positive hemolytic streptococcus. No cases with gonorrheal infection were found among the group with Trichomonas vaginalis vaginitis and none were used for control cases. Direct smear examination, verified by cultures, revealed the presence of yeasts in only 6 of our 59 patients. One of these had Trichomonas vaginalis vaginitis; another had a previous history of trichomonas, but she was apparently cured; 2 had Trichomonas vaginalis vaginitis complicating pregnancy; and 1, who showed no evidence of trichomonas infection, had a profuse leucorrhea. It is apparent from this study that yeasts were not responsible for the vaginitis in the group of women under our observation. It is also obvious that inasmuch as the same group of bacteria was found in the vaginal secretion in the presence of Trichomonas vaginalis as in that without the parasite, the flagellate is responsible for the altered clinical picture. From our clinical and laboratory studies of more than one hundred cases of Trichomonas vaginalis vaginitis over a period of approximately eighteen months, we believe the following conclusions may be drawn:

Visualization of the Pelvic Viscera Iodized Oil and Pneumoperitoneum Combined in Gynecology

WE have used pneumoperitoneum in our study of the female pelvic viscera since 1923, utilizing the transuterine or transabdominal route of inflation in 470 patients. In 150 of these, iodized oil (lipiodol) has been employed in combination with gas for intra-uterine instillation. There has been no accident or untoward result in this series of patients, and in none of those who were operated upon subsequent to the diagnostic procedure was evidence of peritoneal irritation or inflammation found. This can probably be attributed to the careful selection of patients, the judicious choice of route of inflation, careful asepsis and antisepsis, and after-care. Discomfort, which more or less attends this mode of examination, has been minimized by the adoption 0 f a routine which has been followed for some time, almost without exception. The patient is hospitalized, and given a low soapsuds enema about one hour before examination. This is followed by a hypodermic injection of 1/6 grain of morphine and 1/150 grain of ...

Granulomatous peritonitis secondary to perforation of dermoid cyst

Abstract Rupture or perforation is a rare complication of ovarian dermoid cysts, having been reported in the literature as occurring in 0.5 per cent to 4.5 per cent of cases. When granulomatous peritonitis is found at laparotomy, there is no advantage in attempting the removal of the widespread nodules already present as a result of the spill of the irritating fatty contents of the dermoid. Removal of the dermoid prevents the appearance of new adhesions and peritoneal granulomas. Since granulomatous peritonitis grossly presents a picture similar to that of carcinomatosis and/or extensive tuberculous peritonitis, it is essential that a microscopic examination be made for accurate differential diagnosis.

Pneumoperitoneum in Gynecology1

IT is our desire to bring before this Society the results of our study of the practical utilization of roentgenography for diagnosis in gynecology. This method, quite obviously, includes the induction of pneumoperitoneum. The soft structures, the uterus, tubes and ovaries, which otherwise are not distinguishable on the roentgen films, become readily visible when surrounded by air or gas. It is needless before this group of students of roentgenologic methods, many of whom are noted exponents of the method, to recall the history and development of pneumoperitoneum. We pay homage, moreover, to Orndoff, Stein and Stewart, Alvarez, and Sante for their contributions in this field; to Rubin for opening up the gateway of the transuterine route, and to Peterson and Van Zwaluwenburg for the development of the latter for abdominal inflation and for the introduction of the partial knee-chest posture when taking the films after inflation. Following the method of Peterson and his associates, modifying it slightly with ...

Assay of Secretin

Conclusions The commercial secretin preparation, Pancreotest, has been assayed on dogs and found to be half as potent as our standard material. An apparent discrepancy in the expression of units of secretin has been explained.

Intra-Uterine Fetal Death1

THE subject of the diagnosis by roentgenography of intra-uterine fetal death has received rather scant and sporadic attention from obstetricians and roentgenologists up to the present. Spalding and Horner in independent original communications reported three cases each of fetal death at about the same time, 1922,—each describing a so-called pathognomonic sign. Since then a few additional observers—Greenhill, Doub, Moss, Portes and Blanche, Bourland and Spangler—have written upon the subject corroborating Spalding and Horner. When one considers the exceedingly small number of cases by the two last mentioned and the smaller number reported subsequently by the other observers, none of whom had over two cases, it is rather interesting to reflect that what is supposed to be a pathognomonic sign of intra-uterine fetal death has been so unconditionally accepted. Spalding states: “It seems that very shortly after intra-uterine death, the brain tissue shrinks, which produces a typical overlapping of the fetal skul...

Function Tests in the Diagnosis of Biliary Tract Disease Using Sodium Dehydrocholate Or Secretin

Studies by Agren and Lagerlof3 on pancreatic function using intravenous secretin demonstrated that changes in the duodenal biliary pigment concentration might be of use in determining the functional status of the gallbladder. Diamonds, Lakel7 , Snape22 , Dreiling and Hollander9 , have described this biliary pigment response in the secretin test and concluded that good correlation exists between the results of the test and gallbladder function. These workers found that prior to injection of secretin, bile was present in the duodenal contents and that after secretin was injected, all visible evidences of bile disappeared for a variable period of time if a normally functioning gallbladder was present; otherwise the bile color persisted throughout the test period. Tanturi25 , and Still24, have demonstrated that secretin acts directly upon the liver in producing hydrocholeresis. The secretin induced hydrocholeresis tests the capacity of the gallbladder to act as an expansile reservoir. Grossman and co-workers12, have shown that the hydrocholeresis reSUlting from secretin stimulation is less than that resulting from the injection of bile salts. Dr. M. 1. Grossman, suggested to us the use of a bile salt as a means of testing the reservoir capacity of the gallbladder. Sodium dehydrocholate was chosen for use in this study because of its potent hydrocholeretic effect and low toxicity4. 5. ll. 21, even when administered intravenously. Studies by Ivy14, Berman5, Grodinsll, and their associates, have demonstrated that sodium dehydrocholate produced agreater increase in the volume output of bile than did any other agent tested. Clinically, these results have been confirmed in patients with T -tubes. Our previous studies using duodenal intubation, show that an increased volume output of at least 100 per cent over a one-hour period occurs in response to 10 cc of 20 per cent sodium dehydrocholatet intravenously. The peak of this response occurs, on the average, fifteen minutes after injection and an increased flow of bile is noted for at least forty minutes after injection.