Stanley J. Birnbaum

Danazol: An antigonadotropic agent in the treatment of pelvic endometriosis☆

Danazol, an antigonadotropic agent, was administered in a dosage of 800 mg. daily for six months to 32 patients with pelvic endometriosis. Twenty-eight patients (87.5 per cent) were found to have a marked improvement of both clinical and subjective symptoms of endometriosis. Furthermore, Danazol was found to be effective in three patients with chronic cystic mastitis and one patient with fibrocystic disease. There was no change in uterine size in two patients with uterine adenomyosis and one patient with uterine myomas during the treatment period. Danazol was ineffective in relieving the symptoms of the menopausal syndrome in one patient. The main side effects of Danazol treatment were weight gain and water retention which were maximal at four months of treatment and then decreased. Other side effects such as acne, oiliness of skin, and voice change were rare in this series. Danazol therapy was found to be very effective in this study for the treatment of pelvic endometriosis, and the drug was well tolerated by the patients.

Thermographic studies of wound healing

Abstract 1. 1 A series of preoperative and postoperative patients have been studied with newly developed techniques of long wave infra-red sensing and recording instrumentation. 2. 2 Observation and control values of normal abdominal surface infra-red emission have been outlined for further evaluation. 3. 3 The variations of temperature and thermogram patterns in different surgical wounds have been described and compared to previous modalities studied (i.e., the classical phases of wound healing, changes in tensile strength, and biochemical sequences). 4. 4 It has been suggested that the thermographic pattern may be a useful tool in predicting the early evidence of increase in wound tensile strength. It may also note initial evidence of complications or factors prolonging the healing of a surgical wound.

THERMOGRAPHY—OBSTETRICAL APPLICATIONS

Of all the clinical specialties, obstetrics and gynecology may be the most fertile as a potential field of usefulness for thermography. The female pelvic cavity is unique in many respects, Anatomically it is very clearly delineated by fixed bony structures, which allow ready identification of this area on the thermogram with the patient in the dorsal-recumbent or supine position. In addition, the normal pelvic inclination allows us to look almost directly into the pelvic inlet without bony interference. Even the aorta and inferior vena cava divide conveniently into the iliac vessels, when they approach the brim of the pelvis. The fact that these obviously “hot” structures do not traverse the pelvis, but surround it, allows us to more accurately interpret the thermographic pattern of its contents. FIGURE 1 demonstrates the relationship of the skeletal structure to the pelvic cavity as visualized by thermography. The pelvic inlet appears almost oval as a result of the anterior pelvic tilt. The contents of the female pelvis also lend themselves to thermographic analysis. Their relative positions are constant and their normal contour and size stay within reasonable limits. Thus, the uterus and its lateral adnexa are fixed by their ligamentous supports so that they always lie anterior to the rectum and posterior to the bladder. Moreover, the latter two organs may be conveniently emptied to allow better visualization of the internal genitalia. During pregnancy the internal female genitalia undergo progressive changes in size and vascularity that make them most interesting thermographic subjects. It is with the application of thermography to these organs during pregnancy that we are primarily concerned in this paper. Traditionally, pregnancy is divided into three trimesters, and it is within this framework that we shall give our experiences with thermography. During the first trimester, the uterus remains essentially an intrapelvic organ, although from the fourth to sixth week some enlargement is already discernible, and by the 1214th week it is readily palpable abdominally. This increase in uterine volume is accompanied by a great increase in the number and size of its blood vessels, primarily due to the action of estrogenic hormones.’ FIGURE 2 is a thermogram taken during early pregnancy, illustrating the appearance of the vascular uterine tumor gradually filling the true pelvis and encroaching upon the abdominal contents. Note that the uterine emission is rather diffuse; since at this early stage, before the 14th week, the placental area is not well differentiated from the rest of the decidua Vera, and the increase in vasculature is rather generalized. Note also the marked increase in infrared radiation from the breasts during pregnancy. This is a constant change and is again a reflection of the hormonally mediated increase in their metabolism and blood supply. Markee,* in his classical experiments on the menstrual cycle, has shown that under the influence of estrogen and later progesterone, there is a progressive uascularization of the endometrium and increase in cellular activity until the sudden withdrawal of these hormones just before menstruation. The adnexal

CERVICAL PREGNANCY: DIAGNOSIS AND MANAGEMENT

Three cases of cervical pregnancy are described which fulfill all criteria for this diagnosis. The recent literature and management are reviewed. Etiology is discussed with regard to previous curettage as a predisposing factor.

Thermographic and hormonal studies of the placenta in abdominal pregnancy

A case of abdominal pregnancy with the placenta left in situ has been recorded. The gradual dissolution of the placenta was pictorially documented by serial thermography for the first time. Hormone studies and adrenocortical function studies were performed. These failed to illustrate the influence of the placenta on adrenocortical activity but are suggestive that the placenta plays a role in some of the adrenal steroid alterations noted in normal pregnancy.

Antibodies to the neutral glycolipid asialo ganglio-N-tetraosylceramide: Association with gynecologic cancers

As part of our efforts to define subpopulations at increased risk for gynecologic malignancies, sera from 145 women were obtained prior to diagnosis and analyzed for antibody to asialo ganglio-N-tetraosylceramide. This neutral glycolipid is present on the surface of thymocytes and natural killer cells, and asialo ganglio-N-tetraosylceramide antibody has been shown in animals to block natural killer cell activity and promote tumor cell proliferation. With the use of an enzyme-linked immunosorbent assay and with a value of 2 SD above the mean for healthy women designated as the boundary for a positive response, antibody to asialo ganglio-N-tetraosylceramide was detected in only one of 30 (3%) healthy women, none of 16 pregnant women, none of 18 women with benign masses, and two of 24 (8%) women with microbial infections. All of the above samples that contained antibodies were barely over the 2 SD limit. In marked contrast, 19 of 35 (54%) women with gynecologic malignancies had asialo ganglio-N-tetraosylceramide antibodies, with positive values ranging to greater than 10 SD above the control mean. Asialo ganglio-N-tetraosylceramide antibody was found in six of eight (75%) patients with cervical cancer, five of eight (63%) with endometrial cancer, and seven of 15 (47%) with ovarian cancer. Of the eight patients with Stage I gynecologic cancer at any site, five (62%) had asialo ganglio-N-tetraosylceramide antibodies. Four of 22 (18%) women with Hodgkins disease also had antibodies, with values just exceeding 2 SD above control levels. The presence of these antibodies may contribute to an impaired immune surveillance system in these women and so increase their susceptibility to malignancy.

Pseudoectopic intrauterine contraceptive device (a case report)

A case report in which a silver surgical clip was mistaken for the identifying metallic bar affixed to an Antigon intrauterine device (IUD) is presented. The tail of the device was found to be missing during a routine examination. Radiographic examination revealed a metallic clip outside the uterine cavity. Laparotomy however failed to locate the IUD outside of the uterine cavity. In patients wearing an IUD containing a bar metallic marker suspicion of uterine perforation must be carefully evaluated with regard to previous operations and X-rays of the entire abdomen are mandatory.

Pain in the polycystic ovary syndrome

Abstract 1. 1. Four patients with polycystic ovary syndrome are presented, in whom abdominal pain was the predominant presenting complaint. 2. 2. The occurrence of amenorrhea, irregular vaginal bleeding and an apparently unilateral adnexal mass in polycystic ovary syndrome is not unusual. If one adds low abdominal pain and tenderness to this, this group of patients must be included in the differential diagnosis of ectopic pregnancy.