Morris A. Goldberger

Carcinoma of the cervix in Jewish women

Abstract 1. 1. Of 323 patients with carcinoma of the cervix seen at the Mount Sinai Hospital, New York, from 1928 to 1948, there were 80 Jewish women. Eight of these patients had carcinoma of the cervical stump following subtotal hysterectomy. 2. 2. Carcinoma of the cervix in Jewish women, although not common, is not a rare lesion. Carcinoma of the cervix occurs about five times as frequently in the non-Jewish as in the Jewish woman.

Exfoliative dyskaryotic cells associated with atypical cervical lesions.

Abstract 1. 1. Cytologic study of vaginal smears has proved to be of definite value in the detection of early cervical carcinoma and carcinoma in situ. 2. 2. Cervical dyskaryotic cells are atypical and characterized by large, hyperchromatic nuclei, often with a distinct perinuclear vacuole. The cells may be mono- or multinucleated. Some show marked cornification and are acidophilic. 3. 3. The significance of the dyskaryotic smear is discussed. Of 2,000 consecutive cases studied by vaginal smears, 12 showed a predominance of dyskaryotic cells, an incidence of 0.06 per cent. Biopsy study of the cervix in these cases revealed the presence of “atypism” in all instances. The histologic picture included a varying degree of epithelial proliferation, anaplasia, and cell atypism with and without mitosis. The basement membrane was found always to be intact. 4. 4. During a follow-up of 9 months to 4 years, one woman developed a squamous-cell carcinoma of the cervix, 2 years after the initial smear and biopsy. In 2 instances there was a regression to normal. The remaining 9 cases were persistently unchanged. 5. 5. Of 556 consecutive cervical biopsies taken 4 to 10 years ago, 13 showed atypism as described above. Investigation of the present status of these patients indicated that 3 had died of unrelated causes, 9 had remained well, and one had developed a squamous-cell carcinoma of the cervix, 6 years after the initial biopsy. 6. 6. Whether a relationship exists between the finding of a dyskaryotic smear and an atypical biopsy, and the future development of a true malignancy is speculative. The finding of an 8 per cent incidence, 2 and 6 years after the initial biopsy, is suggestive. Repeated vaginal smears and multiple cervical biopsies are most certainly indicated.

A Method for Demonstrating Prepituitary Maturity Hormone in the Blood of Non-Pregnant Women.

Since the prepituitary maturity hormone has been shown to produce puberty, follicle ripening and corpus luteum formation 1 , 2 and since this hormone has been demonstrated in the blood serum and urine of pregnant women and female castrates, 2 , 3 , 4 it appeared logical to expect its presence in the blood of women during the menstrual cycle. Aschheim and Zondek 2 have determined 3 types of action exerted by the maturity factor, follicle ripening (A P R I), blood spots (A P R II) and corpus luteum formation (A P R III). They ascribe these results to 2 distinct hormones which they call Prolan A producing A P R I, and Prolan B causing A P R II and III, but have been unable to devise an exact method for separating these factors. We have attempted to devise a method for demonstrating the presence of either or both Prolan A and B in the blood of nonpregnant women. A convenient material for control is supplied by the serum of pregnant women of which 0.2-0.5 cc. contains a M. U. or R. U. The untreated serum could therefore be used and equivalent amounts of the extracts of the same serum compared with this. The following technique was employed: a. Blood serum obtained from women at various phases of the cycle, from 1 to 22 cc. in amount, was injected into immature mice and rats without conclusive results, b. The proteins of the blood serum were precipitated with acid alcohol (one part serum, 3 parts 95% alcohol). After dilution to 50% the supernatant was separated by centrifu-galization and concentrated to a volume of 6-8 cc. by means of an air current at room temperature.

Significance of Female Sex Hormone Reaction in the Male Blood.

In 1925, simultaneously and independently, Loewe of Dorpat 1 and one of us with collaborators 2 demonstrated the presence of the female hormone in the circulating blood of females by means of the rodent vaginal spread test. 3 Since then, in numerous publications we have attempted to simplify and standardize the method of extracting and testing human blood for the female sex hormone. 4 Among other applications we advocated the use of this test to determine the sex of pseudo-hermaphroditic individuals in whom we regarded a positive reaction, appearing cyclically, as a proof of the presence of functioning ovaries and feminine sex. 5 Our preliminary work had shown that large quantities of bulls blood (150-100 cc.) gave a negative reaction when extracted by our method. The same applied to concentrated lipoid, HCl, saline and watery extracts of bulls testes, as well as extracts of the hypophysis, thyroid and adrenal, liver, muscle, various proteins, etc. 6 The work of Dohrn, 7 who claimed to have obtained a positive reaction with male urine first called our attention to the possible non-specificity of the Allen and Doisy reaction. After our investigation on male bloods had been completed, the short article of Hirsch, 8 who used our method, appeared. In the 4 male bloods which he examined, he has found a positive reaction. To date we have obtained 70 bloods from 55 males. Of these, 10 had to be discarded because the injected mice died early. The technic was that mentioned iii our last article, 4 in which 40 cc. of blood were dried with sodium sulphate, extracted with ether, the dry ethereal cxtract taken up in 2 cc. of water and injected. Our readings are : 0 to −2 =no reaction; 2 to 2+ =weak reaction; −3 to 3 =threshold reaction; 3 to 4 = strong reaction.

Value of hysterography in the diagnosis of large submucous uterine fibroids.

Hysterography can be valuable in the diagnosis of large submucous fibroids. These tumors, when they occupy the entire uterine cavity, form a false smooth wall and are difficult to detect by curettage. In the cases to be reported here, curettage was done for menometrorrhagia by different gynecologists without disclosing the nature of the lesion. Because bleeding continued, hysterography was performed and a large submucous fibroid was found in each instance. Case Reports Case I: R. P., a 27-year-old nullipara, was first seen on May 27, 1948, complaining of irregular bleeding for the last eighteen months. Her menses started at the age of thirteen and until the present illness occurred every thirty days, lasting six days. Treatment had consisted mainly of hormones, administered by mouth, without any effect. The basal metabolism rate, determined three months before admission, was −25 per cent. Three grams of thyroid were administered daily with no effect on the menometrorrhagia, and a repeat basal metabolism t...

Additional data on the treatment of uterine bleeding with snake venom

Abstract In a previous report the therapeutic effects of moccasin venom (Ancistrodon piscivorus) in twelve cases of functional uterine bleeding were presented. 1 The clinical results obtained warranted further trial in cases of this kind. The present report embodies subsequent observations on some of the cases already reported, with the addition of new cases.