John C. Burch

Cooper's ligament urethrovesical suspension for stress incontinence

Abstract Coopers ligament urethrovesical suspension for stress incontinence was first used in 1958. The series now comprises 143 cases. personally selected, operated upon, and followed. The length of the follow-up has varied between rather wide limits; 56 per cent of cases were seen after the tenth month following the operation. 42 per cent of cases after the twentieth month, and 12 1/2 per cent after the sixtieth month. Six cases, 4.2 per cent, were complete failrues and 4 cases, 2.8 per cent, were partial failures in regard to stress incontinenet. The most challenging complication was enterocele, occurring in 7.6 per cent of cases. Seven, 4.8 per cent, of the patients developing enterocele have been satisfactorily reoperated upon, while 4, 2.8 per cent, remain asymptomatic and have not, so far, required operation. As experience has accumulated, refinements in technique and steps to eliminate complications have been developed.

The effects of long-term estrogen on hysterectomized women.

n Presented is a report of 737 women subjected to hysterectomy and subsequently given estrogen therapy with conjugated equine estrogens. A total of 9899 patient-years were studied. The original objective of the study was to evaluate the role of estrogen in the development of carcinoma of the breast. No statistical increase in breast cancer was observed. The most striking finding was the unexpectedly low incidence of all cancer and the markedly low mortality rate. A study was carried out on the subjective response of 550 of the women. Questions were asked on general health, emotional status, and sex. 477 of the women said their health was better, 338 said that their nerves were better, and 181 out of 373 (61 were unmarried) said that sex was better. It believed that due to the use of estrogen, delays were effected in the onset of osteoporosis, and these resulted in an improvement of the incidence of the skeletal fractures which might be anticipated in this age group.n

Results of Estrogen Treatment in One Thousand Hysterectomized Women for 14 318 years

The end of the fertile period of life is marked by the menopause or cessation of menstruation. The post-menopause is long and often occupies one third or more of the life span. It may be accompanied by a period of mental and physical unrest which may be severe.

The Effect of Extracts of the Urine of Pregnant Women on the Hyperplastic Endometrium

Summary This case clearly illustrates the beneficial effects of the extract of urine of pregnant women in a case of endometrial hyperplasia. It also illustrates the fact that the extract may exercise its immediate effect without producing progestational proliferation. However, it is entirely possible that progestational proliferation may occur at some future time in this case.

Experimental Production of Glandular Cystic Hyperplasia of Endometrium with Estrogenic Substances of Parturient Urine

In a recent review of the important gynecological condition of glandular cystic hyperplasia of the endometrium, attention was called to the wide divergence of opinion concerning the amount of estrogenic substance necessary to produce it. 1 The enormous proliferation of the endometrium and the finding of increased amounts of an estrous inducing substance in the blood and urine of a certain percentage of these cases point to an excessive production of estrogenic hormones, as a result the disease is commonly referred to as an hyperestral one, or is said to exhibit hyperestrinism. Evans, 2 Novak, 3 Siebke, 4 Zondek, 5 Frank, 6 Kurzrok 7 and Fluhmann 8 all seem to favor this view. On the other hand the occurrence of the disease in sterile women, its close relation to amenorrhea and its occurrence near the menopause and after partial castration indicate that there is a decreased function of the ovary and a lowered ovarian secretion. Seitz 9 and Mazer and Goldstein 10 have taken this latter view. Due to the rapidly changing opinion as to the rôle of the estrins in the hypophyseal-ovarian complex, and their close relationship to glandular cystic hyperplasia of the endometrium, it seemed important to us to consider the question of the amount necessary to produce glandular cystic hyperplasia of the endometrium. Leaving aside all questions of the accuracy of the biological methods employed in the assay of the estrin content of the human blood and urine, the difficulties encountered in obtaining a sufficiently large number of specimens from the same women in the various phases of the disordered menstrual cycle is so great that it seemed wiser to us to study the changes produced in the castrate guinea pig endometrium by known quantities of labor urine containing a high percentage of estrogenic substances and to measure these changes in terms of vaginal estrous. The guinea pig was selected as our experimental animal on account of its occasional exhibition of the spontaneous occurrence of the condition; the ease of its experimental production in the castrate by injections of estrogenic substance and the well marked estral changes in this species.

The Evaluation of the Hypophyseal Factor in the Interpretation of Endometrial Changes

THE introduction of an efficient and practical method of endometrial biopsy2• 11 has focused attention on the interpretation of endometrial morphology in terms of ovarian function. This ovarian function is controlled by the underlying endocrine activity, so that the endometrium furnishes an easily accessible tissue which by careful histologic study becomes a valuable indicator of the general endocrine state. It is hoped that this histologic analysis can be expanded to replace laborious and often inaccurate bio-assays of blood and urine fact()rs• which are now used. Our own interest in this :field has been concerned largely with the condition generally known as glandular cystic hyperplasia of the endometrium. This subject has recently been reviewed elsewhere and only those phases of the problem related to this study need be considered.