J.Edward Hall

The surgically removed ovary

Abstract The study of 665 cases in which the ovaries were surgically removed has revealed the following facts and permitted certain opinions to be formulated: 1. 1. Although the presence of follicular cysts is usually not considered significant, in this series 45.1 per cent were associated with hypermenorrhea and 64.6 per cent with myomas of the uterus. 2. 2. The benign serous and pseudomucinous cysts occurred about equally in all age groups. 3. 3. The malignant form of the pseudomucinous cyst affects an older age group than the serous type. 4. 4. The large majority of patients having benign cystic teratomas were between the ages of 21 and 40 years. 5. 5. Two-thirds of the patients having fibromas of the ovary were over 45 years of age. 6. 6. The removal of any ovary from a patient under 30 years of age should be done only after a qualified observer has declared that the ovary is abnormal or associated disturbances require oophorectomy. 7. 7. It is urged that normal ovaries should not be removed from women under 45 years of age at the time of hysterectomy for benign lesions. 8. 8. There is no increased incidence of ovarian cysts subsequent to hysterectomy. 9. 9. The advantages experienced from retaining a normal ovary in the women under 45 years of age far outweigh the slim possibility of the development of a primary ovarian malignant tumor. No instance of a primary ovarian malignant tumor occurred in a retained ovary in 71 cases studied. 10. 10. All women in whom ovaries have been retained during a hysterectomy should have pelvic examinations every six months even though the development of pathologic disturbances in such ovaries is rare.

Primary uterine malignancy

Abstract 1. An analysis covering 189 cases of primary malignancy of the uterus has been presented. Ninety-eight cases involved the cervix and ninety-one, the corpus. 2. Sixty-nine patients with cancer of the cervix and sixty-two with cancer of the endometrium were used to determine the survival rates. 3. The five-year survival rate for cancer of the cervix was 40.8 per cent and for cancer of the corpus, 70 per cent. 4. Patients with cervical cancer sought medical advice sooner than those who had corporeal cancer. 5. The histologic grade of the cancer had very little influence on the survival rates in cancer of the cervix, but the stage of involvement was all important. 6. “Contact” roentgen-ray therapy has been an important adjunct in the treatment of cervical cancer. 7. The most important phase in the treatment of endometrial cancer was hysterectomy, but higher survival rates were obtained when radiation was combined with hysterectomy.

Hyperadrenocorticism (Cushing's disease)

Hyperadrenocorticism a condition wherein the adrenal glands (small glands which live next to the kidneys) overproduce cortisol and other hormones. This is due to either too much stimulation from the brain’s pituitary gland (Pituitary dependent hyperadrenocorticism/ “PDH”), or due to a tumor on one of the adrenal glands (Adrenal dependent hyperadrenocorticism/ “AT”). About 85-90% of cases are pituitary dependent, and most of those are due to a small hyperactive nodule in the pituitary, known as a microadenoma. However, some cases are due to a macroadenoma, which is a mass in the pituitary large enough to cause neurologic signs such as confusion, seeming “lost”, unsteadiness on the feet, even seizures. Over time, a microadenoma can grow to become a macroadenoma, but overall, neurologic signs from Cushing’s disease are not a frequent occurrence. Of those 10-15% of cases caused by an adrenal tumor, about half those tumors are invasive and malignant, meaning they can metastasize (spread throughout the body).

Soule: The Practical Value of Vaginal Cytology in Pregnancy. I. Cytological Prediction of the Fate of Early Pregnancy

Acta Cytologica Vol. 8, No. 5, September-October, 1964. *Bamford, S. B., Cassin, C. M., Dilba, D. L., and Mitchell, G. W., Jr.: Neutrophil Appendages as Indicators of Sex Chromosome Aberrations, p. 323. *Soule, S. D.: The Practical Value of Vaginal Cytology in Pregnancy. I. Cytological Prediction of the Fate of Early Pregnancy, p. 364. *Soule, S. D .. The Practical Value of Vaginal Cytology in Pregnancy. II Vaginal Smears During Labor, p. 368.

Carcinoma and dysplasia of the cervix. A comparison of rates for new and returning populations

It is the opinion of the authors that there are changes at the periphery of many of the malignant lesions of the cervix which show no clinical evidence of such change and even on staining of the vagina by the Schiller method do not show any abnormalities. However, these changes can be discovered by the proper colpomicroscopic investigation and cytologic determinations. The realization of this possibility may lead to the discovery of these changes early and, therefore, lead to cure of the patients before invasive lesions develop. The authors believe that because of these changes preoperative radiation therapy in invasive cancer and possibly even in the microinvasive lesions would aid in the destruction of these peripheral zones and, therefore, increase the favorable prognosis of the patient. The main emphasis, however, is on proper postoperative follow-up which should include cytological determination and possibly colpomicroscopy. J. Edward Hall