Samuel A. Wolfe

Gärtner's duct lesions of the cervix

Abstract Gartners duct represents the persisting distal segment of the mesonephric or Wolffian duct. In the adult female it is rarely retained in toto. Segments are most frequently found in the supravaginal cervix. In specimens of cervix obtained by amputation, rests are uncommon. One instance was observed in 1,413 cases. The microscopic appearance is distinctive. Rests produce no symptoms or pathologic changes and are accidentally discovered. Adenomatoid hyperplasia may similarly be only a laboratory finding. Two cases are herein recorded. A case of papillary adenoma of Gartners duct origin has been observed. The symptoms, physical findings and pathologic features are noted. A five-year observation period reveals slow but progressive spread of the lesion.

Two rare ovarian tumors

Abstract The enclosed case reports present the clinical and pathologic aspects of adenofibroma of the ovary and combined multiple fibromata and dermoid respectively. Both were associated with fibroid tumors of the uterus. Their rarity warrants the detailed description given above.

Embryonal carcinoma of the ovary (disgerminoma)

Abstract Three cases of embryonal carcinoma of the ovary are reported. This neoplasm has its exact prototype in the male gonad. Its origin is from embryonal cells of the genital ridge. Teratoid derivation cannot be excluded. Clinically there are no outstanding characteristics but onset early in puberty is frequent. The gross appearance is similar to other solid carcinomas. The histologic picture, however, is distinctive. Large cells with prominent nuclei, supported by a lymphoid stroma produces a classical picture. Diffuse alveolar forms with scant stroma and no lymphocytes have been confused in the older literature with large round cell sarcoma and endothelioma. The prognosis is grave.

Brenner tumor of the ovary

Abstract A small solid type of Brenner tumor was accidently discovered in the left ovary removed for a chronic inflammation. The clinical benignity is indicated. The gross appearance similar to fibroma is emphasized. The constituents of the tumor are (1) proliferating stroma (2) columns of branching epithelium containing clear cells with well-defined borders. True and pseudogland spaces in the solid columns are frequent.

End-results after excision of the cervix interpreted from pathologic findings

0 PERATIVE measures for the relief of leucorrhea aim to remove the infected endocervical mucosa, from which the discharge originates. This paper tabulates the results obtained by conical excision of the cervix in 130 patients operated upon at the Long Island College Hospital, between February, 1927, and May, 1930. Only proved cases of inflammatory cervicitis, and those followed for at least one year are included in this study. Trichomoniasis was excluded in cases of vaginal discharge recurring after operation. Viewed in the light of end-results, removal of the endocervix either by amputation, or the more conservative excision, has not proved entirely satisfactory. R. M. Rawls, in a series frpm the Woman’s Hospital, in which the technic of Emmett was employed, reported 60.7 per cent cured, 31.1 per cent improved, 7.1 per cent unimproved and 1.1 per cent as aggravated following operation. H. B. Matthews, employing the Sturmdorf technic in a series of 70 cases, recorded 70 per cent cured, 22.8 per cent improved, and 7.2 per cent unimproved. In a follow-up group of 75 patients from the Bellevue Clinic, operated upon by the Sturmdorf technic, F. W. Sovak tabulates 88 per cent cured, 4.7 per cent improved, and 5.3 per cent as unimproved. In this series of 130 cases, the Sturmdorf technic was used, although in the older patients and in those requiring extensive plastic operation, removal of the cervix was more radical. Catgut replaced silkworm for the inversion suture in restoration of the portio. Preoperative preparation consisted of thorough application of one-half strength tincture of iodine to the vulva, vagina, and cervix. Where curettage was performed, a quarter-inch iodine pack was placed in the cervical canal and retained during extirpation. In cases of prolapse, douches of bicarbonate of soda and boro-glyceride tamponade were employed for several days prior to operation. In this series of 130 cases, 103 or 79.2 per cent were cured, 23 or 17.7 per cent were improved, and 4 or 3.1 per cent received no benefit (Table I). In one of every five cases therefore the ultimate operative result was unsatisfactory. It is the purpose of this paper to analyze the causes of failure. Broadly speaking, leucorrhea, recurring after cervical operation may be immediate or late. In the latter instance, a symptom-free interval of several months is present and vaginal discharge results from reinfection

The clinical and pathologic features of puberty hemorrhage

Abstract Puberty bleeding clinically designates menorrhagia or metrorrhagia occurring early in menstrual life. These abnormalities are locally independent of inflammation, neoplasia and the pregnant state, as well as of the varied blood dyserasias. They are closely allied to the essential bleeding occurring at the menopause and clinically as well as pathologically both forms overlap. In this communication the puberty group is stressed. A review of 26 cases from the gynecologic services of the General Memorial and Long Island College Hospitals emphasizes the following characters of this disease. 1. 1. Primary menstrual anomalies: Both menorrhagia or metrorrhagia may set in as the initial epoch of sex life or supervene more slowly following oligomenorrhea, hypomenorrhea or other disorders of menstruation. 2. 2. Absence of abnormalities in the general physical examination: This is true in the great majority of cases; yet two in this series showed definite endocrine dyscrasia. Though only fourteen years of age, both of these girls were fully matured, with mammae well formed, the external genitalia fully developed, and the uterus large. The unusual height, 5 ft. 10 in, in one and 5 ft. 6 in, in the other were indicative of abnormal pituitary stimulation. 3. 3. Normal bleeding and clotting time. These tests were performed where secondary anemia was unduly severe and as a rule prior to transfusion. In six instances the findings were within the normal. 4. 4. Pelvic abnormalities: In all cases, the cervix was found unusually soft and patulous. In addition several were noted with enlarged uteri. In all the curettings were abundant and hyperplastic. 5. 5. Recurrence of symptoms after curettage was the rule where abrasion was performed as a therapeutic measure. 6. 6. Excellent therapeutic response, with control of symptoms by radium was universal, even though small quantities were employed. These features are well demonstrated in seven typical cases abstracted below.

Intrapartum and postpartum streptococcus septicemia of extrapelvic origin

I T HE occurrence of a systemic infection arising from an extrapelvic focus and accompanying labor and the puerperium is unique and warrants report. CASE No. 446, 1921.-Mrs. J. M., para vi, was admitted in labor to Dr. Polak% Service at the Long Isl,and College’ Hospital on January 26th, 1921. The patient had been under supervision in the prenatal clinic for three months. Previous labors and pregnancies normal. I?resent prsegnancy uneventful until three days before admission at which time she complained of cough and sore throat. Lab’or began noon January 26th. Notification of same at R:15 P. M. Seen by outpatient service at 9 P. 1~. Exammation showed temperature 102, pulse 116, respirations 24; face flushed; pharynx injected, few subcrepitant rales over both bases. Presentation R. S. A.; cervix 3 cm.; pains every four minutes. Admitted to hospital at 11:30 P. X. with similar findings. Blood count showed 9000 white cells, polys 53 per cent. Labor proceeded s,atisfactorily. At S:50 A. M. (l/27) membranes rupturled spontaneously and living female was delivered spontaneously wi& the next two aontractions. Third stage uneventful. Child weighed 3100 gm.; cried spontaneously but remained cyanotic. The progress of labor was followed throughout by rectal examination. One hour after delivery tempelrature was 104, pulse 130, respiration 38. At this time throat showed white patch on left tonsil in addition to marked injection. Chest showed persistent rbles. Ssecond blood count 12 hours after labor showed (white eells, 24,000, polys 85 per clsnt; high for physiological count). The puerperium was stormy and prolonged and can for purposes of brevity be, divided into three phases. The first periled includes the 1st to 3rd days postpartum. In. this interval the clinical course was characterized by absenee of subjective &symptoms. The physical signs in pharynx and iungs remained unchanged and uterine involution progressed normally. The temperature, however, continued a septic course and varied between 100s and 1042. , pulse persisted between 120 and 140 and respiration b,etween 30 and 40 (see Fig. 2). Laboratory Data :