Tommy N. Evans

A composite picture of the menstrual cycle

Abstract Ten ovulating women were studied to assess the interrelationships of various systemic, hormonal, and reproductive tract changes during normal menstrual cycles. Samples of blood, 24 hour urine specimens, vaginal smears, and cervical mucus were obtained every 2 days pre- and post-menstrually and daily in mid-cycle. Endometrial biopsies were performed at the onset of or immediately before menstruation, and the basal body temperature was recorded. Data for 10 cycles were fed into a computer, and mean reciprocal relationships were determined. The results were: (1) All endometrial biopsies reflected the late secretory phase; (2) there was a simultaneous mid-cycle surge of luteinizing hormone (LH) and folliclestimulating hormone (FSH), and serum concentrations of FSH and LH were significantly lower in the luteal phase compared to the follicular phase; (3) urinary peaks of estrone, estradiol and total estrogens occurred on the day before and that of estriol occurred on the day of the LH surge; (4) serum progesterone began to rise just before the LH peak, reached a high level 7 days after the LH peak, declined precipitately on Day 9, and rose again on Day 10, to decrease slowly until the onset of menstruation; (5) a significant relationship was observed between the LH peak and the basal body temperature; (6) urinary pregnanediol levels closely paralleled serum progesterone concentrations; (7) vaginal cytology revealed a karyopyknotic index peak the day following the LH peak; (8) properties of cervical mucus showed a remarkable relationship to the ovulatory estrogen peak.

Ten year review of hysterectomies: Trends, indications, and risks

This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures.

Cesarean section: A 15-year review of changing incidence, indications, and risks☆

During 15 years (1965 through 1979), 9,718 cesarean sections were performed at Hutzel Hospital. This report concerns the indications, incidence, morbidity, and mortality. Dystocia, fetal distress, and breech presentations were the most common indications for primary cesarean section. The incidence rose from 9.8% to 16.8% during this study. Forceps deliveries dropped from 47.5% to 12.0% and vaginal breech deliveries decreased from 86% to 35%. Spinal anesthesia was used in 90%. Caesarean section hysterectomies were performed in 128. The most common indications were carcinoma in situ of the cervix, uterine leiomyoma, and hemorrhage. Puerperal sepsis and urinary tract and wound infections were the major causes of morbidity. Perinatal mortality decreased from 40% to 29%. There were 10 maternal deaths. Sepsis was the major cause of death. At least four deaths could have been avoided if ultra-high-risk patients had not been pregnant in the first place.

Life in the amniotic fluid

This presentation relates to multiple facets of amniotic fluid changes associated with fetal life. The composition of amniotic fluid is contrasted with that of fetal urine and the implications with respect to the origin of amniotic fluid are discussed. Amniography, fetal radiography, and angiography are presented with respect to recent developments and the role that these modalities have in assessing the fetal status. Amniotic fluid analyses are presented with respect to (1) management of Rh sensitization, (2) fetal maturity, and (3) esterase levels. A correlation is made between the presence of meconium in amniotic fluid and the fetal outcome. Maternal urinary estriol levels appear to be more closely correlated with the fetal status than previously reported in connection with erythroblastosis fetalis.

The artificial vagina

Abstract The etiology of congenital and acquired vaginal atresia is discussed. Ten patients with acquired and 124 with congenital vaginal atresia are presented. Artificial vaginas were constructed in 110. Preoperative investigation and preparation of the patient are essential for success. Selection of the time for operation is critical. Surgical technique is described including that used for construction of a new vagina at time of vaginectomy. Vaginal reconstruction should be considered at the time of any operation which involves removal of the vagina.

Sexually transmissible diseases

There is a widespread recrudescence of venereal disease. The possible reasons for this are discussed. Each disease is then considered from the viewpoints of clinical course, diagnosis, and treatment. Treatment failures are discussed in detail, immunity is covered, and recommendations for the future conclude the presentation.

Studies of antigenicity of human ovarian tissue.

Abstract Normal human ovarian extracts, after homogenization and isonation in physiologic saline, were found to contain specific antigens. These antigens are not serum proteins. They stimulated production of specific antibodies in rabbits. Ouchterlony double gel diffusion revealed two precipitation lines. One component was identical with that found in the human breast, Fallopian tube, and tubular fluid but not in the uterus. Little or no cross-reactivity occurred between ovaries from rabbits, cows, swine, dogs, frogs, turtles, guinea pigs, rats, and monkeys. Immunoelectrophoresis revealed that this antigens mobility corresponded to that of a β-globulin.

Peritoneal lavage and filtration for cytology

Abstract A technique for cul-de-sac peritoneal lavage and filtration is described. Preliminary experience with this procedure suggests its mass application may result in earlier cytologic diagnosis and increased salvage of patients with clinically occult intra-abdominal malignant disease.

Vaginal morphology following hysterectomy

This study was designed to gain more information about morphology of the vagina after hysterectomy. The prospective clinical observations of patients subjected to abdominal or vaginal extrafascial or intrafascial hysterectomy with or without correction of anatomical urinary stress incontinence were included. The length, configuration and axis of the vagina were determined using a vaginal cast technic. Vaginal casts were prepared prior to and 6 months to 4 years after surgery.

Multifocal Mixed Adnexoid Tumors of the Vulva

BENIGN DERMAL NEOPLASMS which differentiate into sweat duct or hairlike structures are commonly described in the skin but are rare in the vulva. A recent report suggests that such vulvar lesions may be more common but are unrecognized because biopsy and histologic examination are necessary to establish the diagnosis. These lesions may differentiate into a single type of skin adnexal structure. They may consist of a mixture of structures of varying degrees of maturation. Pinkus refers to this latter group as mixed adnexoid tumors. Differentiation may be either into eccrine elements (syringoma types) or pilosebaceous elements (trichoepithelioma types). Mixture of the two groups is uncommon and may represent a mixture of separate neoplasms. This report concerns a case in which there was extensive bilateral involvement of vulvar skin by syringomatous and trichoepitheliomatous changes which clinically resembled more common diseases.