Michael L. Leventhal

The Stein-Leventhal syndrome

Abstract This review of the Stein-Leventhal syndrome was undertaken in order to crystallize our present knowledge about it. Although the pathogenesis has not been established, it is considered a possibility that the ovarian changes are due to a “chronic” stimulation by LH. It is possible that the adrenal cortex as well as the ovaries may be involved in the symptomatology in some cases, but this association has not been clarified. Of the many conditions producing amenorrhea, enlarged ovaries, and hirsutism, which must be differentiated from the Stein-Leventhal syndrome, mild adrenal hyperplasia is most important. Determinations of the urinary excretions of the 17-ketosteroids and the “pregnane complex” and the use of the “cortisone suppression” test are valuable aids in the selection of patients for wedge resection.

Bilateral polycystic ovaries the Stein syndrome

Abstract 1.1. There is a definite clinical syndrome, associated with bilateral polycystic ovaries, and characterized by menstrual irregularity, featuring amenorrhea and sterility. Hirsutism is a frequent associated finding. 2.2. The changes in the ovaries are refractory to all present forms of hormonal therapy. 3.3. Restoration of normal menstrual and reproductive function follows bilateral wedge resection of the polycystic ovaries. 4.4. Marked hyperplasia of the theca-interna layer is a constant finding in sections of the ovarian tissue removed. Luteinization of this layer is a frequent finding. 5.5. A working hypothesis for the pathogenesis of this syndrome is presented.

Multiglandular aspects of the Stein-Leventhal syndrome☆

T H E R E have been many empiric treatments in medical history which were Iater proved to be correct. This holds true for the wedge resection of polycystic ovaries. During the first third of this century there were many reports of ovarian resection in the literature. Most often the operation was performed on multicystic ovaries associated with dysfunctional bleeding. Indications for operation were not well established and the results were equivocal. In 1935, Stein and Leventhall reported on a small group of patients who gave a history of menstrual irregularities ending in amenorrhea, infertility, and bilaterally enlarged ovaries. These enlargements were graphically demonstrated by the use of gynecography. Hirsutism was not an uncommon finding. Their declared purpose for resection of the ovaries in the first cases was to obtain tissue for histologic study. In some cases normal menstrual cycles were resumed and pregnancy followed. This satisfying experience aroused their interest in the symptom complex which was so dramatically cured by the simple operation of wedge resection. About 1950, publications began to appear in this country and in Europe confirming their original observa-

Acute segmental dilatation of the cecum without mechanical obstruction following cesarean section

Abstract Two cases of post-cesarean section ileus, associated with severe segmental dilatation of the cecum, are reported. In neither instance was there an organic cause for the ileus, although x-ray films in both patients gave the appearance of mechanical obstruction. One patient required an emergency operation because of the dangerous cecal dilatation, and the other was relieved of a similar situation by the successful passage of a large tube. This life-endangering complication following cesarean section is reported because of its rarity and to alert the obstetrician-gynecologist to the possibility of its occurrence.