J.Robert Willson

The effect of an intrauterine contraceptive device on the histologic pattern of the endometrium

Abstract The histologic pattern of the endometrium of women wearing Margulies polyethylene spirals differs from the normal. The most consistent changes are increased superficial vascularity with the development of large thin-walled vascular channels and the presence of edema in the superficial layers. No cellular changes suggestive of neoplasia were observed.

The surgical correction of congenital aplasia of the vagina

A LTHOIJGH congenital absence of the vagina has been recognized since earliest antiquity, its surgical correction began only a little over a century ago. Since the first reported attempt at surgical correction by Dupuytrenl in 1817, there have been many hectic years of trial and error, of weighing -the psychological evils of the anomaly against the risks of operation. Today, fortunately, all this has changed. There no longer appears to be any valid reason why girls with congenital aplasia of the vagina should not receive the benefit of modern surgical correction, and at a sufficiently early age to minimize psychological trauma. For these young women there are today satisfactory methods of treatment, but this was not always so. Indeed, the cycle through which their wheel of fortune has revolved represents a small, but interesting phase in gynecologic history. Steinmetz2 presented an interesting historical review of the subject in 1940. The incidence of vaginal aplasia is not definitely known, but Engstadt considers one in five thousand births a fair figure. Probably the condition is more common than was formerly believed because some afflicted individuals fail t.o seek treatment and many treated cases remain unreported. While the condition must have been recognized since earliest times, Burrage* states that the first reported case was described by Realdo Columbus in 1752. By 1895, however, Neugebauer had knowledge of one thousand collected cases. The condition represents an embryonal or developmental defect and may reveal itself as a partial OP complete absence of the vagina. Since the genital and urinary organs have a close embryonic origin, developmental anomalies of a,djacent urinary organs may also be encountered. This is an important point to remember since a pelvic mass found in connection with aplasia of the vagina may mean a pelvic kidney. One of our patients had only one kidney (Fig. 1). Counseller a.nd Sluder, Jr.,3 investigated 15 of their patients urologically and found only 6 had normal kidneys. Of the remaining 9, the left kidney was congenitally absent in 6. Two had ectopic pelvic left kidneys and one had a d.uplication of the left ureter.

Complications associated with the use of intrauterine contraceptive devices in women of middle and upper socioeconomic class

The complications associated with the use of intrauterine contraceptive devices by 710 women of middle and upper class strata over a total period of 14,901 woman-months are described. The most frequent was bleeding which occured in almost all women and persisted in 41 per cent. There were three perforations and infection occurred in 1.3 per cent. The pregnanc rate was 2.51 per 100 woman-years of use. The other complications are minor annd have little effect on general health or reproductive function. Since most of the complications are either minor or avoidable, this form of contraception, when properly used, has many advantages over conventional methods.

Obstetrician-gynecologists are primary physicians to women

Michigan obstetrician-gynecologists were asked to complete questionnaires designed to determine what kinds of medical services they provide their patients. The questionnaires completed by 369 doctors, who had graduated from medical school between 1930 and 1964 and who are in active practice, form the basis of this report. More than 50% treat common non-obstetric-gynecologic disorders in their own patients and smaller numbers treat more serious medical conditions. This study confirms a previous one, derived from information obtained from patients, that obstetricians-gynecologists serve as primary physicians to women, not exclusively as specialist-consultants.

Obstetrician-gynecologists are primary physicians to women: II. Education for a new role☆

Our studies of the practice patterns of Michigan obstetrician-gynecologists indicate that they serve in a dual capacity: that of primary physicians to women and that of specialist obstetrician-gynecologists. They provide a considerable amount of general medical care for their own patients in the former role, and traditional specialist services for their own patients and for those referred by other physicians in the latter. The objectives and educational content of most house officer training programs do not reflect these changes. Training is directed almost exclusively toward preparing residents for specialty practice and often does not offer them basic experience and permit them to develop basic skills in other disciplines, notably internal medicine and psychiatry, which they will need to practice as primary physicians to women. An educational program designed to prepare residents more broadly for what they will actually be doing in practice without compromising their training as specialists is described.Our studies of the practice patterns of Michigan obstetrician-gynecologists indicate that they serve in a dual capacity: that of primary physicians to women and that of specialist obstetrician-gynecologists. They provide a considerable amount of general medical care for their own patients in the former role, and traditional specialist services for their own patients and for those referred by other physicians in the latter. The objectives and educational content of most house officer training programs do not reflect these changes. Training is directed almost exclusively toward preparing residents for specialty practice and often does not offer them basic experience and permit them to develop basic skills in other disciplines, notably internal medicine nad psychiatry, which they will need to practice as parimary physicians to women. An educational program designed to prepare residents more broadly for what they will actually be doing in practice without compromising their training as specialists is described.

Multiple hyperbaric exposures during pregnancy in sheep

Eleven sheep were subjected to hyperbaric comparable to 165 feet of sea water 31 times between the one hundred twelfth and one hundred thirty-seventh days of pregnancy. During 13 dives the maternal and fetal circulations were monitored for bubble formation during decompression. Bubbles were detected by external doppler probes in eight of 12 ewes, but in none of the fetuses. Nine ewes were delivered of normal lambs at term. In one, twin fetuses died during an abnormal labor. The pregnancy of another was terminated by cesarean section after decompression to look for bubbles in the fetal circulation.

Ultrasonography in the diagnosis of gynecologic disorders

Ultrasonographic examination is being used with progressively greater frequency as an aid in diagnosis of gynecologic disorders but too often without consideration of whether information other than that obtained from clinical examination is needed and whether ultrasonography can supply it. The size, number, and position of pelvic masses and, in some instances, the type of tumor can be identified, but it is not often necessary when operation is clearly indicated. Ultrasonographic screening for diseases of the reproductive organs has been proposed, but its use for this purpose is limited and it is not cost-effective. It should be used as an adjunct to clinical diagnosis, not as a primary diagnostic procedure.

The university and the community hospital: An experiment in resident education in obstetrics-gynecology

Abstract In 1947, the Department of Postgraduate Medicine of the University of Michigan established a new system of resident education which made the facilities of the Medical Center available to selected community hospitals. The intent of the affiliations was to supplement the clinical teaching in internal medicine, obstetrics and gynecology, and surgery by offering additional work in specially designed courses at the University. Since 1965, a planning committee of representatives from the Departments of Obstetrics and Gynecology of the Affiliated Hospitals and the University Hospital and the Directors of Medical Education has met regularly to discuss problems of residencies in general and to develop a combined program designed to improve resident education in our own institutions. The functions of the committee include the identification of inadequacies, the implementation of corrective measures, and the development of experimental programs. The results of our first 32 months of operation are described.

A university—community hospital affiliation in obstetrics and gynecology: Effect on resident recruitment and education☆

Abstract In August 1965, a long-standing affiliation between the Department of Obstetrics and Gynecology of the University of Michigan and the Departments of Obstetrics and Gynecology of several community hospitals with residency programs was strengthened. The program directors began to meet monthly to discuss mutual problems, the teaching programs for staff and residents were improved and expanded, and students were encouraged to elect rotations in clinical obstetrics-gynecology in the community hospitals. The effect of this program on the number of residents and their quality, as measured by changes in numbers of foreign graduates and performances on examinations, is described.

Erythroblastosis fetalis: A report of four cases

Abstract 1. 1. Four cases of erythroblastosis fetalis, two of congenital hydrops, one of icterus gravis neonatorum with recovery, and one in an infant who died four hours after birth are reported. Blood Kahn tests on all were negative. 2. 2. An interesting family history of many miscarriages, early infant deaths, and the death of three infants with severe jaundice was obtained from the mother of one of the cases of congenital hydrops. The family history in the other cases was not conclusive. 3. 3. Post-mortem examination of three of the cases revealed hepatomegalia, immature cells in the circulating blood, and extramedullary centers of hematopoiesis. Two of the infants had splenomegalia. 4. 4. Following frequent small transfusions totaling 720 c.c. of citrated blood to the patient with icterus gravis neonatorum, the liver and spleen gradually decreased in size, the jaundice diminished, the anemia improved, and the patient was apparently quite fully recovered in thirty days. 5. 5. Erythroblastosis fetalis may be suspected if the placenta is large, pale, and friable, and there is an increased amount of amniotic fluid which may or may not be yellow tinged.