John C. Weed

The gonadotropin receptor of the human corpus luteum

Abstract Homogenates of human corpora lutea specifically bound 125 I-human luteinizing hormone (HLH). This binding was proportional to tissue (receptor) concentration and the receptor was saturable. Binding of 125 I-HLH was markedly reduced at 4° C. or in the presence of 10 I.U. human chorionic gonadotropin (HCG) or 2.4 I.U. of HLH (LER-907). LH from other species (ovine, bovine, and porcine) as well as other trophic hormones tested did not compete with 125 I-HLH. Specific binding of 125 I-ovine or 125 I-bovine LH could not be demonstrated. An apparent dissociation constant (Kd) of ∼3 and ∼9 × 10 −9 M was observed for two corpora lutea (Day 28 and Day 16) with lactoperoxidase labeled 125 I-HLH. In examining 125 I-HLH binding from over thirty corpora lutea from different times of the menstrual cycle, it was concluded that midluteal phase corpora lutea bound more 125 I-HLH than did older or younger corpora lutea. Day 14 corpora lutea and aged corpora lutea did not specifically bind 125 I-HLH. Ovarian stromal tissue failed to specifically bind 125 I-HLH, even when derived from ovaries that yielded corpora lutea which did bind 125 I-HLH. These results indicate that the human corpus luteum possesses a specific LH receptor. This receptor appears to require a conformation thus far found only in HLH and HCG.

Metastasizing leiomyoma: a case report.

IN 19 3 9, Steiner’ published a report of a patient who died as a result of extensive pulmonary metastases of a benign-appearing leiomyoma. histologically identical to the multiple leiomyomas present in the uterus. About 12 well-documented cases have since been reported in the world literature. Whereas criteria of malignancy are lacking, these leiomyomas behave clinically much like low-grade sarcomas. We are presenting an additional case report of a patient whose clinical course typifies those most commonly encountered.

Conservative management of cervical intraepithelial neoplasia.

A brief review of cervical intraepithelial neoplasia has been presented. Attempts have been made to identify the high-risk patient, and etiologic considerations have been detailed. The conservative management of cervical intraepithelial neoplasia is available and applicable to many patients. Regardless of the definitive therapy used in CIN, it is absolutely mandatory that proper pretreatment evaluation be performed. This includes cytology, colposcopy, colposcopy-directed biopsies, and clinical examination to rule out invasive cancer. If this can be done according to the stated criteria, one may proceed with outpatient treatment. If performed accurately, such treatment can be very effective, saving the patient a major surgical procedure. This is of tremendous benefit to the patient in time and money saved, as well as to the saving of hospital bed space and operating-room time. For the young patient who has not yet completed her family or the patient who is pregnant, outpatient evaluation is probably the optimal method. If the techniques are unavailable or the physician managing the patient does not have the expertise to perform them, standard management by means of conization, which historically has been used in this disease, should continue to be used. The consequence of inadequate outpatient management of CIN can be catastrophic. If the procedures are properly followed, then the patient with CIN can be managed safely and effectively.

Endometriosis and Infertility: An Enigma

In our efforts to overcome infertility and subjective complaints in young women with endometriosis, we have performed conservative surgical procedures upon 142 women 30years of age or less. In these women, multiple endometriomata were resected from the pelvic peritoneum, one or both ovaries, the large and small bowel, and the appendix. In addition, uterine and ovarian suspension, bowel resection, appendectomy, myomectomy, and presacral neurectomy (PSN) were performed when indicated. Conception occurred in 70% of the women wishing to conceive; the highest rate was found among those who had developed endometriosis after a previous conception. Ovarian involvement seemed to reduce the conception rate by 10%. Uterine suspension and PSN did not affect conception but did provide symptomatic relief. We conclude that early examination for endometriosis and aggressive surgical management is indicated in young women with demonstrable disease.

Hemangioma of the cervix

Abstract A patient with hemangioma of the uterine cervix diagnosed clinically because of its gross appearance was subjected to vaginal hysterectomy for associated pathologic lesions. Microscopic examination of the cervix revealed a cavernbus hemangioma involving chiefly the portio vaginalis. portio vaginalis.

Total hysterectomy at cesarean section and in the immediate puerperal period.

Abstract 1. 1. Eighty-five total hysterectomies at cesarean section or post delivery are herewith presented. Ten are from private practice, and 75 are from the Tulane Obstetrical Services. 2. 2. Although the total number were collected within a three and one-half year period, they represent a small percentage of the total number of cesarean sections performed (150 per year). The present section rate is 3.72 per cent (Tulane). 3. 3. Approximately 44 per cent of the sections are repeat sections and 23 per cent are for disproportion. These added to the relative high incidence of toxemia, fibroids, and abruptio placentae in the Negroes (80 per cent of total deliveries) will eventually produce many women in whom hysterectomy is indicated. 4. 4. The indications for total hysterectomy at cesarean section or in the immediate puerperium are the same as for the subtotal or Porro section. 5. 5. The uterus is amputated above the cervix and the technique for removal of the cervix is described. 6. 6. There were no surgical complications in 73 patients. Seven exhibited shock, 2 hemorrhage, 2 afibrinogenemia, and 1 spinal shock. 7. 7. Postoperative complications were observed in 30 cases consisting of atelectasis (mild), mild ileus, urinary tract infection, and shock. There were two pelvic hematomas of minor degree, 1 cuff hemorrhage, 3 instances of anuria, and 1 of abdominal wound separation. 8. 8. Thirty patients were morbid for 1 or more days (35.3 per cent) and 7 for 3 or more days (8.2 per cent). 9. 9. There were 19 stillbirths, 7 of which occurred in ruptured uteri, 10 from abruptio, 1 from erythroblastosis, and 1 from neglected transverse lie, a rate of 22.3 per cent. 10. 10. Two maternal deaths (2.35 per cent) were incidental to the procedure. One of these mothers had long-standing pertionitis associated with uterine rupture, and the other, with eclampsia, abruptio, Couvelaire uterus, and lower nephron nephrosis, died on the twentieth postoperative day of a cerebral thrombosis. 11. 11. Operative experience has shown that there is no cause to leave the cervix in situ for fear of increased bleeding or operative time. Postpartum vaginal support has been universally sound.

Microinvasive cancer vs occult cancer

Carcinoma of cervix, Microinvasion, Occult. By definition, Stage I-A carcinoma of the cervix is microinvasive cancer. As the name connotates this lesion can only be diagnosed microscopically, and to its fullest degree only in a conization specimen. Abnormal cytology can identify a patient with an early invasive lesion; however, diagnosis of microinvasion requires more sophistication than diagnosis of intraepithelial neoplasia or invasive disease. When cytology or directed biopsy suggests an early invasive lesion of the cervix, this mandates a conization for adequate evaluation. Only with proper histologic preparation can the lesion be delineated accurately and proper treatment applied. Unfortunately, opinions differ about the exact diagnosis and the most appropriate therapy for microinvasive carcinoma of the cervix. Ruth* called this lesion “a confusing dilemma”; he found fifteen different names for the disease entity as well as six histologic definitions from a review of the literature that covered only a four-year time interval. The International Federation of Obstetricians and Gynecologists (FIGO) has not defined this lesion histologically.’ In fact, FIG0 has probably added somewhat to the confusion over this lesion since the definition and staging of this entity has been changed four times since 1960. In an attempt to define this lesion better, in 1973 the Society of Gynecologic Oncologists accepted the following statements about microinvasive carcinoma of the cervix uteri: 1) A case of intraepithelial carcinoma with questionable invasion should be regarded as intraepithelial carcinoma; 2) Microinvasion should be defined as one in which the neoplastic epithelium invades the stroma in one or more places to a depth of three millimeters or less below the basement membrane, and lymphatic or vascular involvement is not demonstrated. Although this statement was not accepted unanimously, it does offer a definition for purposes of discussion. Notwithstanding the considerable concern over depth of invasion, vascular or lymphatic involvement, and confluency, the virulence of the lesion probably is related to the volume of disease, and volume to a certain degree is reflected by these histologic parameters. Lohe and associates7 recently assessed microinvasive carcinoma from their own material and reviewed the world literature, they have added considerable information to our knowledge of this disease entity. They further break down early invasive disease into two categories as follows: 1) Early stromal invasion, projections of tumor penetrating the subepithelial connective tissue, and 2) Micro-carcinoma, invasion involving the stroma to a maximum length and width of 10 mm. and a maximum depth of 5 mm. The authors meticulously evaluated the histologic preparations from their patients; 285 had early stromal invasion and 134 had microcarcinoma. When they reviewed the 285 patients with early stromal invasion plus an additional 895 like patients from the literature, they noted that radical surgery was performed in only about one-fifth of the patients. None of their 285 patients died of early stromal invasion, although 4 patients were considered to have recurrence. Thirteen of the 895 patients from the literature had tumor recurrence (1.5%), but only 4 of these patients (0.4%) died from their disease. Radical surgery was performed in approximately half of L.ohe et al’s7 134 patients with micro-carcinoma plus the 435 like patients who were identified from the literature. Three of the 134 patients with micro-carcinoma had recurrence of tumor; all died of their disease. Tumor recurred in 24 (5.5%) of the 435 micro-carcinoma patients from the literature; 14 (3%) of these died. However, 10 of the 14 patients from the literature who died of their micro-carcinoma probably had stromal invasion greater than 5 mm. Lohe et al7 concluded that the risk of dying of early stromal invasion regardless of the treatment modality was rather small since none of their 285 patients and only 4 of 895 from the literature (0.4%) succumbed to their disease. The risk of dying of micro-carcinoma was higher since 3% of those from the

Management of vesicovaginal fistula

Abstract Vesicovaginal fistula has become a complication of gynecologic, obstetric, and urologic surgical procedures more frequently than of difficult vaginal delivery. It still occurs occasionally as the result of an infectious process, malignant disease, or irradiation injury. A few instances of vesicovaginal fistula after vesical neck resection in children will occur despite the most careful surgical technique. In 75 patients with vesicovaginal fistulas encountered at the Ochsner Clinic since 1942, repair was accomplished in 60, chiefly by the transvaginal approach. Eleven with malignant fistulas were treated palliatively, and 4 refused additional surgical treatment. Meticulous preoperative preparation should be followed by adequate exposure, watertight closure of the bladder wall, and plication of the pubocervical fascia over the bladder closure. Postoperative care should be designed to accomplish good wound healing with emphasis on estrogen replacement, high protein diet, and supplementation of the ascorbic acid intake. Urinary diversion may be necessary if the musculature of the bladder neck has been destroyed or if contracture of the bladder prevents adequate filling. The vaginal approach offers the best chances for cure.

Vaginal hysterectomy: Analysis of 305 consecutive cases

Abstract A detailed analysis of 305 consecutive cases of vaginal hysterectomy with a mortality rate of 0.65 per cent is presented.

Evaluation of epitestosterone and testosterone excretion in polycystic ovary disease and other ovarian disorders.

Abstract Urine excretion of epitestosterone and testosterone has been measured in patients with functional ovarian abnormalities. These included patients with known polycystic ovary syndrome treated by wedge resection, suspected polycystic ovary syndrome treated medically, patients with primary ovarian failure, and pregnancy with hirsutism. Patients with polycystic ovary syndrome had a characteristic increase in excretion of epitestosterone following ovarian stimulation with human chorionic gonadotropin. Measurement of testosterone was less helpful in predicting the presence of polycystic ovaries. Measurement of epitestosterone was also found to be of value in detecting primary ovarian failure where epitestosterone levels are very low and response to HCG stimulation is minimal. The measurement of urine epitestosterone before and after stimulation with HCG appears to be a useful confirmatory test of ovarian stromal hyperfunction in the anovulatory patient suspected of having polycystic ovarian disease.