Norman F. Miller

The surgical correction of congenital aplasia of the vagina

A LTHOIJGH congenital absence of the vagina has been recognized since earliest antiquity, its surgical correction began only a little over a century ago. Since the first reported attempt at surgical correction by Dupuytrenl in 1817, there have been many hectic years of trial and error, of weighing -the psychological evils of the anomaly against the risks of operation. Today, fortunately, all this has changed. There no longer appears to be any valid reason why girls with congenital aplasia of the vagina should not receive the benefit of modern surgical correction, and at a sufficiently early age to minimize psychological trauma. For these young women there are today satisfactory methods of treatment, but this was not always so. Indeed, the cycle through which their wheel of fortune has revolved represents a small, but interesting phase in gynecologic history. Steinmetz2 presented an interesting historical review of the subject in 1940. The incidence of vaginal aplasia is not definitely known, but Engstadt considers one in five thousand births a fair figure. Probably the condition is more common than was formerly believed because some afflicted individuals fail t.o seek treatment and many treated cases remain unreported. While the condition must have been recognized since earliest times, Burrage* states that the first reported case was described by Realdo Columbus in 1752. By 1895, however, Neugebauer had knowledge of one thousand collected cases. The condition represents an embryonal or developmental defect and may reveal itself as a partial OP complete absence of the vagina. Since the genital and urinary organs have a close embryonic origin, developmental anomalies of a,djacent urinary organs may also be encountered. This is an important point to remember since a pelvic mass found in connection with aplasia of the vagina may mean a pelvic kidney. One of our patients had only one kidney (Fig. 1). Counseller a.nd Sluder, Jr.,3 investigated 15 of their patients urologically and found only 6 had normal kidneys. Of the remaining 9, the left kidney was congenitally absent in 6. Two had ectopic pelvic left kidneys and one had a d.uplication of the left ureter.

The cytologic diagnosis of endometrial adenocarcinoma.

An outpatient diagnositc technique comparable to the Papanicolaou smear for carcinoma of the cervix is needed to permit early recognition of adenocarcinoma of the endometrium. Five different techniques of sampling the endometrial cavity were carried out on 1, 742 patients at the University of Michigan Medical Center. A total of 2,553 specimens were correlated with operating room curettings to assess the accuracy of each sampling technique. The methods of saline irrigation with an antrum cannula, endometrial brush sampling, high-vacuum aspiration, and the Gravlee jet washer proved not to be accurate enough to be used as a routine screeening test. There was excellent correlation (96 per cent) between endometrial biopsies and curettings. In our experience, endometrial biopsy with a suction or basket curette was the diagnostic technique short of curettage which permitted accurate diagnosis.

THE EFFECT OF X-IRRADIATION ON HeLa DURING DIFFERENT PHASES OF THE GROWTH CYCLE

Monolayers of the established HeLa strain were exposed to various doses of x radiation during different phases of the growth cycle. The effects as measured by changes in cell and clone number were dependent on the radiation dose. Four days after irradiation was the optimum day for assessing irradiation damage in this system. Significant variations in the radiation sensitivity of HeLa during different stages of the growth cycle were observed by both assessing procedures. Cells in the logarithmic growth phase were most sensitive to radiation, followed in order by cells in the negative growth acceleration, stationary, and latent phases of the population cycle. The ranges of these differences were greater by cell than by clone count methode. The closest correlation between the two techniques was observed when radiation was administered during the logarithmic phase of growth. It is hoped that these studies may eventually facilitate the development of a satisfactory assay system for measuring the in vitro radiation sensitivity of short-term monolayer cultures of tumors, as well as the long-term monolayer cultures of established cell strains. (auth)

VIRAL STUDIES OF THE FEMALE REPRODUCTIVE TRACT.

Abstract Standard cell culture techniques were employed in an attempt to isolate viruses from gynecological material. Several different cell lines were used in the tissue culture system and many different culture conditions were employed. One hundred and eighty specimens were collected from normal individuals and those with a variety of gynecological conditions. The only viral agent isolated was identified as herpes simplex. The protozoan T. vaginalis was isolated and grown in association with cultured cells. Three continuous cell lines were isolated from cultures inoculated with clinical specimens. The hypothesis that the female reproductive tract harbors a number of viruses is discussed.

Irradiation sensitivity of cervix cancer: Response of cultured cervix cancer cells to irradiation☆☆☆

Abstract 1. 1. A new in vitro approach to the problem of predicting irradiation sensitivity of female genital tumors is described. 2. 2. The results indicate that some carcinomas are relatively resistant to irradiation, whereas others are readily destroyed. Although the results appear promising, it is premature to assume that irradiation sensitivity of cultured cancer cells in vitro truly reflects the tumors response in vivo.

Surgical approaches to postobstetrical perineal body defects (rectovaginal fistula and chronic third and fourth-degree lacerations).

Rectovaginal fistulas and chronic anal sphincter lacerations are uncommon complications that are most often secondary to vaginal delivery, gynecologic surgery, and inflammatory bowel disease. In this chapter, we will review the pertinent anatomy, focusing on the 6 structures that should be considered during the repair and surgical techniques to promote restoration on normal anatomy and function. Key concepts include a tension-free repair, meticulous hemostasis, and postoperative bowel management.

Detection of characteristic differences in the irradiation sensitivity of four human cancer cell strains.

Monolayers of four human cancer cell strains were exposed to various doses of x radiation during different phases of their growth cycles. The effects as measured by changes in cell number were dependent on the radiation dose. The dose-response curve of each strain varied significantly when radiation was administered during different stages of the population cycle. With three strains, HeLa, RP Ca Vu I, and RP Ca Ov I, the cells at the beginning of the logarithmic growth phase were more sensitive to radiation than cells entering the negative growth acceleration phase. With the other strain, RP Ca Cx I, the reverse was true. Highly significant differences in the radiation sensitivity of the four cell lines were detected when radiation was administered during the fourth culture day, a period when the cells were entering the phase of negative growth acceleration. The characteristic differences appear to be consistent with the generally accepted radiotherapeutic susceptibility of the tumors from which the cell lines were originally derived. (auth)

The application of a silver carbonate stain for the diagnosis of uterine cancer by the vaginal smear method

Abstract 1.1. The silver carbonate staining method of Hortega was modified for staining the cellular elements of vaginal smears. The details of the procedure are described. 2.2. The affinity of chromatin material for the silver stain, together with the usual hyperchromatic character of atypical cells, combine to make this a useful stain in the diagnosis of uterine cancer by the vaginal smear method. 3.3. The cytoplasmic and nuclear characteristics of cells impregnated with silver carbonate are described and several noteworthy advantages of the technique over other conventional differential stains are listed.

Posture and dysmenorrhea

Abstract A consecutive four year study of young college women for the purpose of determining what, if any, relationship exists between posture and common gynecologic symptoms was undertaken. This study was begun in 1927, and the collection of data completed in 1931. Though initial examination was made of 785 young women, it was found at the end of the four year period that there were complete consecutive four year records on only 302. Improvement in posture was demonstrated which occurred quite as consistently among those who had no dysmenorrhea at any time as it did among those with pain at each period. Whether this improvement was real or only apparent could not be positively determined. No unusual change was noted in the subjective or objective characteristics of the menstrual periods. So far as constitutional type was concerned the average nondysmenorrheic woman was found to be slightly taller and to have more pronounced breast development.

Of what value is the male hormone in the management of genital cancer in the female

Abstract The use of hormone therapy in the management of some cancers has been stabilized considerably during the past decade. The use of estrogen as an aid in the control of prostatic carcinoma is now well established. Similarly the use of male hormone as adjuvant therapy in breast carcinoma in the female is likewise accepted. The supplementary use of the sex hormones in the management of certain malignant diseases has led to clinical trials of many varieties. Many reports of clinical trials have appeared in the literature. Some have dealt with the use of male hormone in the management of genital cancer in the female. Most of these reports did not permit definite conclusions because they were based on too short a period of observation. In order to obviate this objection we undertook a planned three-year study, which forms the basis for this report. Since three-year mortality rates indicate fairly well the survival rates which may be anticipated in five and ten years, a three-year study should permit reasonable evaluation of the usefulness of the male hormone as adjuvant therapy in genital cancer of the female. Briefly stated, our program consisted of giving new, previously untreated patients with genital cancer admitted to our gynecological service at the University of Michigan Hospital during the year 1946, (1) our customary irradiation therapy, and, (2) in addition, male hormone as adjuvant medication. It was our plan to continue male hormone therapy for this group of patients (1946) for a three-year period, at the end of which time it would be possible to compare the three-year survival rate for this group (1946) with a control group of patients similarly treated except for the use of male hormone (1945). Since all of our gynecological cancer patients are traced, giving us a 100 per cent follow-up over a nineteen-year period, it was believed this study would give us considerable information concerning the effect, if any, of male hormone upon survival rate.