Joseph W. Goldzieher

Dysmenorrhea and ovulation: correlation of the effect of estrogen therapy on pain the endometrium and the basal body temperature.

Treatment of dysmenorrhea by the suppression of ovulation with estrogen therapy is reported. 178 cycles of treatment were studied in 30 patients. The correlation of dysmenorrhea and ovulation was studied by endometrial biopsy and basal body temperature (BBT). 82 biopsies and 11 temperature records were obtained from 5 patients. In 50 baseline (untreated) cycle 46 progestational and 4 estrogenic endometriums were seen. Pain was associated with progestational biopsies. Of 32 biopsies taken after treatment 21 were progestational and 11 estrogenic. An ovulatory BBT was also associated with a progestational endometrium and with pain. In 91 cycles treated with less than 25 mg of remarin or less than 20 mg of diesthylstilbestrol (DES) 25.3% were totally relieved. In 53 cycles treated with 25 mg remarin or 20 mg DES 49.1% were totally relieved. In 23 cycles treated with 75 mg and 60 mg respectively 78.3% were totally relieved. All failures were associated with a progestational endometrium. In order to establish the optimal dosage for individual patients it is advisable to follow treatment with endometrial biopsies and BBT. Gross menstrual disturbances were absent during treatment.

Characteristics of the normal menstrual cycle.

Previous studies which have shown that the lengths of apparently normal menstrual cycles vary widely and that absolute regularity in the individual patient is exceptional have not eliminated anovulatory cycles patients with subtle endocrine disturbances and such lesser disturbances as travel monor illnesses or alterations of working hours. Variable schedules make data based on nurses especially suspect. In this study 109 women were carefully selected and all cycles showing late hours restless sleep travel febrile illnesses and other disrupting factors were eliminated. Of the 524 recorded cycles 500 or 95.4% were ovulatory 13 or 2.5% were anovulatory and 11 or 2.1% were indeterminate. All 58 biopsies from cycles with ovulatory temperature patterns revealed progestational endometriums. Of the 500 ovulatory cyc les 0 were shorter than 19 days; 1 was longer than 60 days; 3.2% were 19-22 days; 21.4% were 23-25 days; 53.6% were 26-29 days; 17.8% were 30-36 days and 4% were longer than 36 days. More than 1/2 were 26-29 days and 92.8% fell within the 23-26 day interval. Comparison with the data of others shows that when anovulatory cycles are eliminated short cycles (less than 19 days) apparently disappear from the curve. Studies with a larger number of mature women have fewer anovulatory cycles. In 79.6% of the women the estrogenic phase was 10-16 days long. In 1.9% it was less than 10 days in length but in 15.6% it was 17-25 days and in 2.9% longer than 25 days. Except for 1 progestation rise which was only 5 days long the progestational phase was 8-19 days long. 69.5% showed progestational phases of 11-14 days 94.0% of 10-16 days 1.8% less than 10 days and 4.3% 17-19 days. This confirms the belief that the unusual length of the ovulatory cycles results from a longer estrogen phase. In 68.4% of patients bleeding was 3-5 days in duration and in 95.4% 3-7 days. The mean temperature differential between pre- and pos tovulatory phases is often relatively small (.2-.5 degrees F). In 78.9% the rise was .6-.9 degrees F. This emphasizes the value of recording the temperature in degrees Fahrenheit on a relatively large scale rather than using a small scale or degrees Centrigrade.

Metabolic abnormalities in obesity: a statistical survey.

The metabolic status of 100 unselected cases of obesity was surveyed and compared with that of other groups selected from consecutive clinic cases according to their fat distribution, age and clinically apparent endocrinopathy.

Genetic Disorders of the Endocrine Glands.

The authors state that this work is an attempt to catalogue the clinical, genetic, and metabolic features of the known genetic disorders of the endocrine glands. If their effort had been kept within these limitations, it would be difficult to fault. Unfortunately, they were unable to resist writing a mini-book of endocrinology; in failing this most difficult of tasks, they have detracted from an otherwise excellent work. Worst of all, there are one- or two-sentence therapeutic summaries that are likely to set any endocrinologists teeth on edge. Aside from matters of emphasis where a reviewer might disagree with the authors (as for example with their rather euphoric praise of human growth hormone therapy), there are some surprising errors and omissions. The role of triiodothyronine as the tive thyroid hormone goes unmentioned. Statements about steroid transformations on page 226 are incorrect, and the steroid biosynthetic scheme outlined on page 218 is

Essentials of Clinical Endocrinology.

Schneeberg and his contributors (Banghart, Bendersky, Eskin, Paul, Shaw, Smith, and the Steinbergers) have accomplished exactly what they set out to do in superb fashion: prepare a tight, up-to-date synopsis of clinically relevant endocrinological information. The style is simple and straightforward, and it makes an extraordinary density of information quite readable. A very practical clinical orientation is evident throughout: in discussing the treatment of hyperthyrodism, Schneeberg states: Criteria useful in selecting individual treatment are outlined below, but the choice depends to a large extent on the experience of the physician, local surgical skills and isotope facilities, and the convenience, comfort and wishes of the patient. How refreshingly different from the usual dogmatic recommendations! In controversial areas, the author treads a very reasonable middleground; perhaps the necessity for conciseness made it impossible to indicate in greater detail the range of authoritative opinions. However, the reader is given excellent bibliographic referrals, should

ESTIMATION OF URINARY SODIUM

To the Editor:— InThe Journalof June 25 appeared an article by Bryant and his co-workers entitled Estimation of Urinary Sodium. Certain misconceptions and questionable features should be discussed publicly, lest they aid in perpetuating ideas and practices now considered out of date. The authors state that daily determination of sodium is expensive and so complicated as to be prohibitive even in the hospitalized patient. The flame photometer, though expensive, is a simple and relatively accurate instrument and is in wide current use. For those institutions where the equipment and technical help for this machine are not available, there are extremely simple and accurate chemical methods which do not require special equipment (Goldzieher, J. W., and Stone, G. C. H.: J. Clin. Endocrinol. 9 : 95-100, 1949) and are not expensive. The authors base their test on old data which showed that sodium and chloride excretion run roughly parallel in