Samuel Lubin

Vascular patterns in the human ovary

Abstract A study of vascular patterns in the human ovary has been presented. The vascular system in the human ovary is more complex than that of the rabbit. However, it shows helical spiralling with gradual diminishing diameters in the branches of the main ovarian artery. The function of spiralling in the ovarian branches of the arterial system are (1) adaptation of the vasculature to ovarian growth, and (2) to provide a mechanism for the reduction and regulation within the ovary of blood pressure. A relationship exists between arterial spiral distortion resulting from ovarian cysts, corpora lutea, and the arrangement of the ovarian veins. Characteristics of the ovarian artery and its branches have been described. The relation of the condition of the vessels to ovarian activity and inactivity have been discussed. It is suggested that there is a relation between growth and development of ovarian arterial branches and estrogenic activity in the adult. Evidence is presented to show that branching of the arteries in the ovary from late fetal life to shortly after birth is under the influence of maternal hormones. Observation of the venous vascular tree shows completely different characteristics when compared to the arteries.

Vaginal hemorrhage due to potassium permanganate.

Abstract Ten cases of vaginal bleeding are presented in which the causative agent was potassium permanganate either in tablet, crystal or douching fluid. Bleeding was severe enough in five cases so that the patients were in shock on admission and required transfusions of whole blood from 800 to 1,500 ce. The bleeding was controlled readily with packing in the maJority of the cases and only two required suturing of a free vessel. Only one case aborted to our knowledge, and the patient used quinine and perhaps other agents as well. In this particular case bleeding from the ulceration was minimal. In the district about the hospital the number of patients employing the introduction of potassium permanganate for the production of abortion is increasing as evidenced by the fact that only one case was seen in 1946 and 1947, two cases in 1948 and six cases in 1949.

Dependence of ovarian spiral arteries on the trophic action of estrogens.

Patterns of spiral arteries in rabbit 1 , 2 , 3 and human Sovaries 4 , 5 have been described. Although there are differences in the arrangement of these vessels in the two species, homologous parts may be discerned. In the human, the ovarian artery passes along the hilus of the ovary, inosculating with its uterine branch. This may be called the basic branch and compares with the same vessel in the rabbit which lies wholly outside the ovary. There are numerous short tortuous vessels arising primarily from this basic vessel in the human and these primary branches compare with the single (or sometimes double 2 ) ramus ovaricus in the rabbit. In the human, each primary branch normally gives rise to a number of still smaller helical blood vessels that pass in the folds of the posterior duplicature of the broad ligament as this envelopes the ovary. These secondary vessels compare with the ovarian spiral arteries originally described in the rabbit. 1 , 2 They give rise in turn to clusters of still smaller tertiary spiral arteries. In the course of injecting the blood vessels in a series of about 60 pairs of human ovaries, 5 observations have been made on the distribution and character of the secondary and tertiary blood vessels in the human ovary. It is clear that, in the absence of estrogen these vessels undergo progressive involution and eventually disappear. They are highly developed, dense and numerous only in the presence of estrogen. The evidence for this is as follows: a) In 4 hypertensive subjects past the menopause, the ovaries were sclerotic, one endometrium atrophic, and there were few or even no secondary and tertiary ovarian spiral arteries. b) One normotensive subject with a recent menopause had a uterus with an actively proliferating endometrium. Her ovaries were sclerotic, but the secondary and tertiary ovarian arteries were profuse and well developed although the vessels were more widely spaced than in menstruating women. c) Two hypertensive subjects, not yet past the menopause, possessed non-sclerotic ovaries. The ovarian spiral arteries were luxuriant and profuse. d) Three normotensive premenopausal women possessed sclerotic ovaries and either proliferative, or early secretory endometria. The secondary and tertiary ovarian spiral arteries were profuse and highly developed.

Intravenous Demerol in the second stage of labor

Abstract This study was conducted to estimate the safety and analgesic effect of intravenous Demerol (1-methyl-4-phenyl piperidine-4 carbonic acid ethyl ester) in the second stage of labor and was observed in a series of 339 cases. In recent years Demerol has been used extensively for obstetric analgesia. The pharmacology has been adequately reviewed and its efficacy demonstrated by other workers. Much of the literature describes the use of Demerol by the intramuscular route and most often in combination with other drugs such as scopolamine, Seconal, Amytal, and Nembutal, to produce a degree of amnesia and analgesia. Mention has been made of its administration by the intravenous route. Most recently Brown, Volpitto and Torpin1 presented a series of cases where intravenous Demerol and scopolamine were used during labor, but not during delivery. There is no agreement as to the optimum dosage nor the safest time to administer the dose preceding delivery; some authors recommend administration 2 hours prior to delivery, others 1 hour, implying that administration closer to parturition may result in serious fetal narcosis. Yet there are reports of intravenous administration of Demerol when delivery was imminent, at full dilatation of the cervix, and also in the second stage up to within 10 minutes of delivery without adverse effect on the fetus. Clinical proof that Demerol usually has relatively minor adverse effects on the fetus when it is used to produce obstetrical analgesia, has been described by Way and co-workers.2 The authors originally began the present series to determine in a wellcontrolled study the optimum time for administration of intravenous Demerol before delivery. This, obviously, would be the point at which maximal maternal analgesia and minimal fetal narcosis could be obtained. In addition, it soon became evident that it might be possible to devise a safe and readily accessible anesthetic method for use in those localities where other forms of anesthesia are not easily obtainable.

Postpartum hematomas: Report of four cases

Abstract 1. 1. A summary of the etiology, recognition and management of postpartum vulvar and paravaginal hematomas is presented. 2. 2. Four cases of this postpartum complication are reported. 3. 3. Three patients of this group were treated actively by opening of the hematoma, evacuation of the blood clots and packing. In addition, blood transfusions and supportive therapy were given. All patients made an uneventful recovery. 4. 4. One patient progressed satisfactorily and fully recovered under expectant treatment.

Missed abortion: An analysis of results following conservative management

Abstract A series of 18 cases of missed abortion is presented where the dead ovum was retained for at least twenty-eight days and up to one hundred and ninety-six days. No patient, in the series reported, presented alarming symptoms of retention, as toxemia, hemorrhage, or infection. Conservative management was employed. There was no maternal mortality and in only one case was there any morbidity. The Friedman test was of value only when negative. Roentgenologic evidence of fetal death did not coincide with the Friedman test in more than 50 per cent of the cases. The period of retention varied inversely with the stage of the gestation at which death of the ovum occurred. Surgical and hormonal induction of labor is discussed along with the pertinent physiology.

The Effects of Progestin on Afterpains

Summary We have reported observations showing the complete relief of afterpains in 87.1 per cent of cases by the administration of a single dose (one rabbit unit) of progestin. Normal processes of the puerperium were unaffected.

Missed abortion: An evaluation of conservative management

Abstract 1. 1. A series of thirty-nine cases of missed abortion is presented in which a non-viable dead fetus was retained for at least twenty-eight days. 2. 2. Surgical evacuation of the retained ovum was not attempted in any patient in this series. 3. 3. Only seven patients required any assistance toward completion of the active aborting process. 4. 4. There was no maternal mortality and in only one case was there any morbidity. 5. 5. The only deaths from missed abortion in Brooklyn during the past ten years resulted when surgical interference was instituted. 6. 6. Laboratory data indicative of fetal death are not entirely reliable except when the Aschheim-Zondek test is negative and roentgenologic study indicates positive evidence of death of the fetus. 7. 7. Surgical and hormonal induction of labor are discussed, together with the pertinent pathologic conditions.

Female genital tuberculosis treated with streptomycin

Abstract A case of endometrial and cervical tuberculosis, secondary to extrapulmonary tuberculosis, treated with streptomycin continuously for three months, is reported. While clinically the patient is improved and has no complaints, the microscopic evidence of the infectious process still persists in the cervix and endometrium.

Krukenberg tumor with involvement of the appendix

Abstract 1. 1. The observation is made that metastatic involvement of the appendix, a supposedly rare complication which was found in this case, is probably a more common occurrence than is generally believed. This is probably also true of other structures hitherto considered to be rarely the seat of metastasis in this malady. 2. 2. Detailed reports of many more cases of Krukenberg tumor than are at present available are necessary in order to solve some of the important problems arising in connection with this neoplasm.