Stewart A. Fish

Mumps Oophoritis: A Cause of Premature Menopause *

One cause of secondary oligomenorrhea is ovarian infection. A rare type of infection related to the disturbance of menstrual function is mumps oophoritis. Three patients with premature menopause presumably caused by this agent were described. In one patient the symptoms coincided with a subclinical infection during the perinatal period, with subsequent infertility. Another patient seemed to have had a clinically mild oophoritis during the pubertal period, and the third patient became symptomatic following parturition. It appears that this aberration in menstrual function and fertility may be related to the time during which the infection occurs as well as to the severity of the infection. In addition, it is apparent that mumps oophoritis may be a more frequent cause of premature menopause than has heen previously suspected.

The effectiveness of two oral contraceptives in suppressing plasma androstenedione, testosterone, LH, and FSH, and in stimulating plasma testosterone-binding capacity in hirsute women

The effectiveness of two oral contraceptives in suppressing plasma androstenedione (A), testosterone (T), LH, and FSH and in stimulating testosterone-estradiol-binding globulin (TeBG) was evaluated in 39 hirsute women. Twenty-seven hirsute women received norethindrone 2 mg.-mestranol 0.1 mg. (Group I) and 12 received norgestrel 0.5 mg.-ethinyl estradiol 0.05 mg. (Group II). Hormone assays were performed before treatment and at the end of 3 weeks of therapy. Ninety percent of the women in both groups had an elevated plasma A and/or T. During treatment, plasma A,T, LH, and FSH were significantly reduced in both groups (p less than 0.01). In Group I, 78% of the women had a normal plasma A and T during treatment. In Group II, 83% of the women had a normal A and T during treatment. There was a greater increase in TeBG in Group I (p less than 0.01). It is concluded that these two oral contraceptives effectively suppressed the hyperandrogenism of most of the hirsute women.

Familial Male Pseudohermaphroditism without Gynecomastia Due to Deficient Testicular 17-Ketosteroid Reductase Activity

Abstract To evaluate possible 17-ketosteroid reductase deficiency, we studied two sisters with primary amenorrhea, hirsutism, clitoral enlargement and a 46,XY karyotype, who lacked breast development. Plasma luteinizing hormone, follicle-stimulating hormone and urinary 17-ketosteroids were elevated in both subjects. Plasma Δ4-androstenedione was seven to nine times greater than normal, whereas plasma testosterone was low or in the low-normal male range. Spermatic venous plasma of Case 2 contained increased amounts of Δ4-androstenedione and estrone and subnormal amounts of testosterone and estradiol, findings consistent with testicular 17-ketosteroid reductase deficiency. In vitro incubation of testicular tissue of Case 2 confirmed a partial defect in testicular 17-ketosteroid reductase activity and documented increased 3β-hydroxysteroid dehydrogenase activity. Failure of breast development was probably due to lower estrogen levels than in previously reported cases. We conclude that testicular 17-ketostero...

Metabolites of meperidine related to fetal depression.

Abstract Three specific patterns of meperidine metabolism were observed in the maternal serum of 52 patients studied. These patterns appear to be related to the rate of formation of certain metabolites of the compound. No observable signs of infant depression were detectable when delivery was performed during the first 60 minutes following the administration of the analgesic agent regardless of the type of pattern. However, when greater than 60 minutes had elapsed following intravenous injection of meperidine the incidence of depressed infants was directly related to the more rapid metabolic patterns. Therefore, the most significant factors relating infant depression to meperidine are the maternal metabolic pattern and the length of time the patient is in labor following the administration of the compound. These observations presumably reflect the increased toxicity of certain metabolites of meperidine transferred to the fetus from the mother. Thus, if delivery takes place within 60 minutes after injection, the level of metabolites of meperidine in the fetus should be low and the chance of a depressed infant reduced.

Counseling the patient with sickle cell disease about reproduction: Pregnancy outcome does not justify the maternal risk!

A retrospective study of 35 HbSS and 15 HbSC pregnant patients was undertaken to illustrate the hazards to both mother and child of gestations associated with these hemoglobinopathies. It was found that these patients experienced a 10% to 14% maternal mortality rate and a 51% to 55% perinatal mortality rate. The fact that the mother, due to her illness, cannot care for the child, coupled with the poor medical health that the offspring themselves have if they too inherit the homozygous gene, provides additional support to the concept that some form of relief should be offered these women. Based on the figures of this study and those of others, aggressive genetic counseling to the women is advocated including liberal surgical sterilization and primary abortion in certain cases.

Familial ovarian hyperthecosis: A study of two families☆☆☆

Abstract Two families containing 41 women with hirsutism and/or oligomenorrhea were studied. Ovarian histology of eight demonstrated hyperplasia of theca cells in atretic follicles, a paucity of primordial and developing follicles, and stromal hyperplasia. Elevated levels of androstenedione and/or testosterone and luteinizing hormone (LH) were found. Estradiol and follicle-stimulating hormone (FSH) were low. Following bilateral ovarian wedge resection, the LH and FSH levels of the proband of Family I were normal. Three men of Family I had low plasma testosterone and an abnormally high LH/FSH ratio similar to that of the women. Conclusions were: (1) Ovarian hyperthecosis can be inherited; (2) the inheritance is consistent with an autosomal dominant pattern, but X-linked inheritance cannot be ruled out if the males are excluded; (3) the abnormal LH/FSH ratio can serve as a biochemical marker; (4) ovarian wedge resection corrected the abnormal LH/FSH ratio in one case; and (5) ovarian hyperthecosis may be a type of gonadal dysgenesis.

The lecithin/sphingomyelin ratio in cases associated with fetomaternal disease

The efficacy of correlating the L/S ratio in the amniotic fluid with fetal lung maturity has been substantiated in normal pregnancies. In gestations complicated by fetomaternal diseases, however, the assay is less reliable. This study involves 555 pregnancies in which there was a significant maternal, fetal, or placental disorder. The L/S ratio was related to fetal respiratory maturity as measured by Dubowitz criteria and the occurrence of RDS. The results show that pre-eclampsia, chronic hypertension, diabetes (Class D, E, F), significant cardiovascular disease, severe hemoglobinopathies, various congenital anomalies, chronic placental insufficiency, and prolonged ruptured membranes accelerated the L/S ration. Conversely, mild diabetes (Class B, C), intrinsic renal disease, hepatitis, collagen disease, hydrops fetalis, syphilis, and toxoplasmosis were associated with a delay in the L/S ratio. A significant increase in erroneous responses was noted in these patients when the L/S ratio was correlated to infant maturity and to the incidence of RDS. Possible mechanisms for these findings are discussed.

Metabolites of meperidine in the fetal and maternal serum

Although meperidine appears to be the safest obstetric analgesic agent, it has been associated with infant respiratory depression in certain situations. It would appear that the incidence of fetal depression related to meperidine is dependent on the time of injection prior to delivery, the quantity of drug administered, and the rate of maternal metabolism of the analgesic. Previous work showed that meperidine is metabolized in the maternal system by one of three patterns. The present study demonstrates that the particular maternal serum pattern is characteristic for the individual, regardless of whether the patient is pregnant or not, and that the fetal depression, although usually mild, can be correlated with fetal pH data as well as Apgar scores. In addition, this study supports indirectly the contention that metabolites of meperidine rather than the parent compound cause fetal depression. It would appear, therefore, that in certain obstetric cases with a higher probability for infant depression, other analgesic agents might be considered, especially if the serum pattern indicates meperidine is being metabolized.

Features of Turner's syndrome in women with polycystic ovaries.

Four women with phenotypic features of Turners syndrome and with poly cystic ovaries (PCO) are describe. In addition to the phenotypic features, Case 1 had primary amenorrhea and small PCO, Case 2 had a 46, XX/45, X karyotype (lumphocytes), Case 3 had enlarged PCO which contained a decreased number of oocytes, and Case 4 had enlarged PCO and was short in statute. These cases support the concept of a relation between PCO and the X chromosome. Some PCO may represent an intermediate condition in a spectrum that extends from the streak gonad of Turners syndrome to the normal ovary. Evidience for X chromosome involvement in PCO is summarized. The concept is advanced that at least some cases of OCO may be due to X chromosomal factors causing an abnormal follicular appartus.

Cerebral spinal fluid studies in eclampsia

Abstract During the 5 year period 1966–1970, 94 eclamptic patients were delivered of infants at the City of Memphis Hospitals. The cerebrospinal fluid of the last 21 patients was studied in an attempt to clarify the various neurological manifestations of this syndrome. The results were compared with cerebral spinal fluid obtained at delivery from 25 patients with severe pre-eclampsia, 10 with chronic hypertensive vascular disease, 9 with documented seizure disorders, and 35 patients with normal term pregnancies. Nineteen of the 21 eclamptic patients had bloody spinal fluid (hematorrhachis), and this finding, in addition to others, is correlated with neurological deficits and prognosis.