Warren R. Lang

The delay period in carcinoma of the vagina: With observations on age incidence and survival rate

Abstract From our data we have concluded that: 1. The incidence of carcinoma of the vagina is related to increasing age. 2. No racial predisposition was noted. 3. The most common presenting symptom was abnormal vaginal bleeding. 4. In approximately 25 per cent of cases there was no delay in diagnosis. The incidence of physician delay was about the same as patient delay. In approximately 30 per cent of cases, the total delay to diagnosis exceeded 8 months. 5. There was usually no delay from diagnosis to treatment. 6. Fourteen per cent of the patients have already survived more than 5 years. 7. No relationship could be observed between length of delay and outcome.

End results in adenocarcinoma of the endometrium managed by preoperative irradiation

Abstract 1. 1. Table XV presents a summary of the 5 year results in 297 patients seen during the 34 years, 1921 to 1954. 2. 2. Irradiation, especially with intrauterine radium, has played a prominent part in the therapy. In operable cases it has been used primarily to devitalize the carcinoma and thereby prevent manipulative spread and local recurrence. 3. 3. The preferred method of treatment has been intrauterine radium followed in 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Sixty per cent of the patients were treated by less satisfactory methods, usually because the carcinoma was advanced or the patient was a poor operative risk.

Teen-age dysmenorrhea; a statistical evaluation of the role of suggestion in treatment.

Abstract 1. A total of 2,706 girls of four secondary schools in two separate experiments were questioned about dysmenorrhea before and after a period of routine body-conditioning exercises. Students of the experimental schools were repeatedly told that the exercises would cure dysmenorrhea; students of the control schools were told nothing about any possible effect of the exercises on dysmenorrhea. 2. None of the schools showed any significant change in the incidence of dysmenorrhea from the beginning to the end of the experiment. 3. Of those free of dysmenorrhea at the beginning of the experiment, 12.4 to 20.6 per cent suffered from dysmenorrhea at the conclusion. 4. There was no significant difference in “cure” rate between control and experimental schools. Altogether, 23.1 per cent of those with dysmenorrhea were relieved of dysmenorrhea. This figure may be taken as an estimate of the proportion of teen-age cases which resolve spontaneously during an interval of six months to a year.

Evaluation of a new contrast medium for hysterosalpingography.

Summury Visco-Rayopake (diethanolamine salt of 2, 4-dioxo-3-iodo-6 methyl tetrahydropyridine acetic acid) a new opaque medium, which was introduced by Rubin in 1941 has been found to be highly satisfactory for x-ray study of the uterine tubes. The outstanding advantage of this substance is due to the fact that it is well tolerated by the tissues and is rapidly absorbed from the peritoneal cavity. It was used to study the patency of the uterine tubes in 79 patients. In 25 of these, the Visco-Rayopake flowed freely into the peritoneal cavity where it. was absorbed within thirty minutes.

Benign cervical erosion in nonpregnant women of childbearing age; a colposcopic study.

Abstract Benign cervical erosion is one of the most frequent findings noted in pelvic examination. 1, 2 It has been evaluated by cytologic studies, very exhaustively by histopathologic investigations, but quite rarely by colposcopy. 3–5 Since colposcopy (magnified stereoscopic visualization of the cervix under bright illumination) affords a panoramic view of the cervical portio and refines gross inspection, we believe it can add to our knowledge of benign as well as malignant cervical change. Hence the use of colposcopy in this study. The term cervical erosion is a clinical one indicating an area of velvety reddening of varying intensity and extent surrounding the anatomical external cervical os. Many names are used more or less interchangeably, some with connotations of mechanism or causation: cervicitis, endocervicitis, eversion, ectropion, pseudoerosion, diseased cervix, and, much less commonly, misplaced or heteroplastic endocervical tissue, 6 vermilion halo, 7 and mucoepithelial hyperplasia. 8 Various self-explanatory adjectives are also applied: simple, follicular, glandular, papillary, cystic, friable, polypoid, nonspecific, ulcerative, chronic, congenital, and acquired. The prime symptom of erosion is leukorrhea; occasionally there is bleeding. Grossly, the cervix may suggest malignant change. The true nature of the lesion cannot be determined by naked-eye inspection and further evaluation may be necessary to ascertain more definitely the presence or absence of malignancy. Our aim in this study is to determine what is present colposcopically when a woman has a benign cervical erosion, including an attempt to ascertain whether there is a loss of surface epithelium, as some 9, 10 believe, or whether a covering surface epithelial layer is present. 11–13 To simplify matters we have chosen to limit our investigation to nonpregnant women of the childbearing age.

Therapeutic exercises for teen-age dysmenorrhea

Abstract 1. 1. During a period of more than 8 years, 5,324 girls of nineteen Philadelphia Junior High, Senior High, and Vocational Schools were treated for dysmenorrhea by either the Billig or Mosher exercises. 2. 2. Both exercises gave approximately the same results. On the average, more than three fourths of the girls were either “cured” (complete absence of symptoms for at least the last 3 months of follow-up) or improved. This rate varied from school to school and ranged from 60 to 100 per cent. 3. 3. The over-all average of “cure” per school was 20 per cent. This is practically the same per cent of cases that, in a previous study, resolved without any therapy. 4. 4. Although there is no specific evidence in our study that exercises affect the rate of total cures, they seem to offer a simple easy approach for at least partial relief of dysmenorrhea.

Chordotomy for the pain of gynecologic malignancy

Abstract The principles, indications, contraindications, and complications of chordotomy have been briefly presented. In thirty-five cases of carcinoma of the female genital tract four out of five of our patients experienced total relief of pain. These results seem to warrant consideration of the procedure in properly selected patients with a reasonable life expectancy.

Bibliography of Parts Three and Four

Bibliography of Parts Three and Four Bibliographie des 3 et 4 parties Literatur zum dritten und vierten Teil Symposium sur les urétrites non-gonococciques Monaco, 1954, vol. 1, p. 101 (Masson, Paris 1957) Symposium international sur les infestations à trichomonas Reims 1957, vol. 1, p. 381 (Masson, Paris 1958) Ackermann, A.: Derm Z. 71: 132 (1935). Allen, E.: Amer. J. Obstet. Gynec. 30: 565 (1935). – Amer. J. Surg. (1936). – Amer. J. Obstet. Gynec. 45: 246 (1943). – Amer. J. Obstet. Gynec. 51: 387 (1946). Allen, E. and Butler, S.: Amer. J. Obstet. Gynec. 51: 387 (1946). Allison, G. G.: Sth. Amer. J. Med. 36: 82-23 (1943). Appelbaum, E. and Leff, W. A.: J. amer. med. Ass. 138, 119 (1948). Archawsky, M. and Samina, M.: Urologija 13: 255 (1943). Barnes, J.: Les infestations à trichomonas, p. 352 (1957). – Bull. St. fr. Gynec. 28: 222 (1958). Barnes, J.; Boutwood, A,; Haines, E.; Lewington, W.; Lister, E. and Haram, B. J.: Brit. med. J. /; 1160-62 (1957). Barretto, M. P.; Filho, Z. M.; Oliveira, P. M. W.; Medonca, J.; Saguis, J.; Guimaraes, J. and Vila, E.: Rev. Ass. Med. brazil. 4: 126 (1958). Bauer, H.: Derm. Wschr. 115: 49 (1942). – Z. Urol. 5: 224 (1952). – Zbl. Gynäk. 7: 246 (1952). – Derm. Wschr. 136: 37 (1957). – Rapport Sté de Dermatologie, Erlangen 28 juin (1957). – Gynéc. prat. 8: 361 (1957), – Les Infestations à Trichomonas. p. 21 (1957). Baum, H. C.: Med. Clin. N. Amer. 42: 263-65 (1958). Bedoya, J. M.: Gynéc. prat. 8: 403 (1957). – Gynéc. prat. 8: 413 (1957). – Tricomonasis sexual humana. (Facta, Valencia 1959). Bedoya, J. M. and Fdez.Ortega, J. M.: Gynéc. prat. 2: 97 (1958). Bedoya, J. M. and Rios, G.: Geburtsh. Frauenheilk. 10: 989 (1958). Bedoya, J. M., Rios, G. and Rico, L. R.: Geburtsh. Frauenheilk. 8: 990, 994, 997 (1958). Bensen: Arch. Schiffsu. Tropenhyg. 12: 661 (1908). Beric, B. and Miletic, M.: Zborn. Rad. Inst. Fiziol. (Beograd). Trecieg Kongr. Ginek. Jugoslav. (1956). Bieren, S.: Med. Ann. D. C. 22: 17-22 (1953). Bland, P. B. et al: Amer. J. Obst. Gynec. 32: 835 (1936). – J. amer. med. Ass. 115: 1013 (1940). Bland, P. B. and Rakoff, A. E.: Vida nueva 37: 467 (1936). Bonestell: J. Parasit. 22: 511 (1936). Bordo: West. Vener. Dermat. 3: 54 (1957). Bourne, A.: British Obstr. and Gynec. Practice, Vol. 2. (Heinemann, London 1955). Brady, L. and Ried, R. D.: Amer. Surg. 115: 840 (1942). Breindl: cit. par Sebek in Shornik lek. 43: 1 (1941). Brewer, J. I.; Halpern, B. and Thomas, J.: Amer. J. Obstet. Gynec. 74: 834 (1957). 166 Bibliography of Parts Three and Four Bushby, S. R. M.; Catterall, R. D. and Williamson, M.: Brit. med. J. /: 78-80 (1955). Buu-Hoi‚N. P.;Xuong, N. D. and Zajdela, F.: Bull. Soc. Chim. Fr. //-/2.-1591 (1955). Buxton, L.: Obstet. Gynec, N. Y., Vol. 12, 6: (1958). Bykhowsky and Gouchansky: Ann. Mai. vénér. 30: 92 (1935). Candiani, G. B.: La Trichomoniasi vaginale. p. 172 (Salpietra, Florence 1953). – Rev.

Regression, recurrence, and regression of epithelial atypism of the cervix as indicated by cytologic smear, colposcopic findings, and schiller iodine staining.

Abstract A case report of unusual cervical changes in a nonpregnant multiparous Negro woman is presented. With two episodes of pelvic inflammation, cytologic, colposcopic, and iodine-staining findings became abnormal, with normal findings in between the two episodes and after the last one. Biopsy subsequent to the second pelvic inflammation showed a lesion variously diagnosed from severe atypism to early invasive carcinoma. On thorough study of the operative specimen no malignancy was found. The implications of these findings are discussed.