S. Leon Israel

Teen-age obstetrics: A cooperative study

Abstract A comparison was drawn between 3,995 teen-aged obstetric patients and that of 40,709 parturients of whom the teen-agers were a part (9.8 per cent). Among the teen-aged patients a distinctly higher incidence was noted in the occurrence of pre-eclampsia and anemia, as well as a somewhat increased incidence of one-day fever, puerperal morbidity, and labors in excess of 20 hours. Cesarean section was performed less frequently among the teen-agers. Essentially no difference was observed in fetal, neonatal, and perinatal mortality. The same was true of the incidence of abnormal presentation, transfusion, laceration, hemorrhage, intercurrent disease, and dystocia. This study has re-emphasized the fact that teen-age obstetrics presents no greater challenge than obstetrics in general. It has also reaffirmed a well-known observation—the nonwhite woman is heir to many more obstetric complications than her white counter-part.

The challenge of metastatic ovarian carcinoma

Abstract 1. 1. In the course of reporting the clinical and morphologic data of 33 malignant tumors metastatic to the ovary and 6 additional unproved ones, the subject of secondary ovarian cancer is reviewed. 2. 2. It is averred that carcinoma metastatic to the ovary occurs with sufficient frequency to warrant more consideration by gynecologists in their preoperative differential diagnosis of a solid ovarian tumor. 3. 3. It is asserted that, on occasion, it is impossible for the pathologist to be certain that an undifferentiated malignant tumor of the ovary is of primary or secondary origin. 4. 4. It is reaffirmed that the eponymic term for secondary ovarian cancer, Krukenberg tumor, is not uniformly used by either clinicians or pathologists. Inasmuch as the variable criteria applied to define it merely heighten confusion, it is suggested that the eponym has outlived its purpose and that it should be dropped from usage.

Obstetric behavior of the grand multipara

A retrospective study of 5551 grand multiparas was undertaken to collect statistically valid and clinically comparable information on the risks of pregnancy in this group with parity of 7 or greater. 60% of the women were nonwhite and two-thirds were 34 years or younger. Grand multiparas made up 4.3% of all obstetric patients seen during the 3-year (1958-1960) study in 13 collaborating hopsitals. A hemoglobin of less than 10 gm-percent occurred more than twice as often among grand multiparas; nonwhite women had more anemia than white women but excessive multiparity dramatically heightened the incidence of anemia among white women. Preeclampsia and hypertension occurred significantly (p.001) more often in grand multiparas than in women of lower parity. Abruption and previa of the placenta both occurred significantly (p.001) more often in grand multiparas. Uterine rupture (.28%) postpartum hemorrhage (5.3%) and transfusion required (6%) occurred nearly twice as often in grand multiparas. There was an absolute increase in the occurrence of breech and transverse presentations among grand multiparas and maternal morbidity was 50% greater. Maternal mortality was not increased.

NORMAL PUBERTY AND ADOLESCENCE

The normal process of puberty and adolescence of girls is characterized by orderly growth. It occurs during a span of years during which, in addition to distinct bodily changes, there are psychological alterations leading to psycho‐sexual maturity. The menarche occurs in a setting arranged by an unfolding series of measurable somatic changes, the time of its appearance being a signpost of inestimable value. It is considered to be normal when it appears between the ages of nine and 16. The irregular character of early menstrual cycles is physiologic.

Ovarian cystectomy: A neglected operation

Abstract Ovarian cystectomy, an operation designed to remove a benign cystadenoma and to spare a functioning portion of the ovary, should be more widely employed. This ovary-conserving procedure is indicated for the relatively youthful woman who has an obviously benign cystic tumor of the ovary; it has no place either in women of the fifth decade or when there is any doubt concerning the benign nature of the cyst. The authors technique of such cystectomy, modified from the one popularized by Victor Bonney in 1946, is illustrated by drawings, and a satisfactory 8 year experience with 40 such operations is detailed.

Artful Versus Trade-School Gynecology

The tragedy of sterility is needlessly imposed too often; the practice of gynecology must include medical as well as surgical treatment.Before deciding on surgery for benign conditions, the gynecologist must consider the importance to women of the reproductive process and of continued marital function. Plastic reconstruction of the vagina and hysterectomy for benign tumors should be reserved for patients with unmanageable symptoms.Cystectomy is recommended for all unquestionably benign ovarian cysts in young women.The removal of normal ovaries during hysterectomy is a debatable procedure.

MENSTRUAL DISORDERS OF ADOLESCENCE.

Adolescent menstrual disorders include precocious puberty, delayed menarche, dysfunctional uterine bleeding, and dysmenorrhea. The menarche normally takes place between the ages of 9 and 16 years. Precocious puberty of constitutional origin, by far the most common variety, is characterized by accelerated but otherwise normal sexual maturation. Recognition of delayed maturity hinges on other evidence of “lateness” and on absence of endocrine stigmas. Early in adolescence the menstrual cycles are often bizarre by adult standards. Progesterone is the mainstay of therapy for abnormal uterine bleeding in adolescence. Dysmenorrhea deserves special attention because it engenders fears of marital or reproductive disaster.Adolescent menstrual disorders include precocious puberty, delayed menarche, dysfunctional uterine bleeding, and dysmenorrhea. The menarche normally takes place between the ages of 9 and 16 years. Precocious puberty of constitutional origin, by far the most common variety, is characterized by accelerated but otherwise normal sexual maturation. Recognition of delayed maturity hinges on other evidence of “lateness” and on absence of endocrine stigmas. Early in adolescence the menstrual cycles are often bizarre by adult standards. Progesterone is the mainstay of therapy for abnormal uterine bleeding in adolescence. Dysmenorrhea deserves special attention because it engenders fears of marital or reproductive disaster.