Willard M. Allen

Traumatic laceration of uterine support; the clinical syndrome and the operative treatment.

Abstract A series of 28 cases has been presented in detail to illustrate the syndrome of the “universal-joint” cervix. A complete evaluation has been recorded of the presenting complaints, history of associated obstetrical misfortunes, and pelvic pathology encountered at laparotomy. The simple surgical detail necessary to alleviate symptoms has been described and pictured. Finally, a detailed postoperative evaluation of results obtained concludes the study.

Physiology of Corpus Luteum VII. Maintenance of Pregnancy in Rabbit After Very Early Castration, by Corpus Luteum Extracts

In a recent series of papers 1 we have described the preparation and effects of an extract made from the corpora lutea of swine. When administered to recently spayed adult rabbits, or to immature rabbits whose uteri have been brought to the mature resting state by injections of oestrin, the corpus luteum hormone (progestin) induces alterations of the endometrium characteristic of pregnancy. If female rabbits are mated and castrated 18 hours later, while the fertilized ova are still in the Fallopian tube, the extracts substitute for the removed ovaries so completely that the embryos are nourished, become implanted, and develop in the uterus exactly as in normal pregnancy under the influence of the mothers own corpora lutea. In the third of our previous reports we have described 2 animals which were carried to the 13th and 19th days of pregnancy respectively. The demonstration of normal implantation with normal foetuses in these animals at autopsy led us to attempt to carry other animals through the full term, with the results now to be reported. The procedure in general was as follows: A doe was mated, usually to 2 bucks, and was subjected to bilateral double oöphorectomy 18 hours after mating. The number of ruptured follicles in each ovary was noted. Administration of the extract by subcutaneous injection was begun on the day of operation and was continued daily thereafter. The preparation used was the crude oily extract described in our second paper. About the 8th to the 12th day of the experiment the animal was again explored under ether anesthesia, for the purpose of determining whether or not implantation had taken place. This procedure enabled us to conserve the costly extract in case the pregnancy had not continued.

Chronic pelvic congestion and pelvic pain

Abstract Attention is drawn to broad ligament lacerations and pelvic congestion as a cause for incapacitating pelvic pain, backache, and dyspareunia. Surgical repair of the lacerations usually eliminates the symptoms. Hysterectomy should be considered for those patients with the choronic pelvic congestion syndrome in which sterilization is also indicated.

Carcinoma of the cervix: results obtained from the irradiation of the parametrium with radioactive colloidal gold.

Abstract During the four-year period of 1950 to 1953, inclusive, 324 patients with cancer of the cervix, League of Nations Stages I, II, and III, have been treated by two quite different methods. One group was treated with x-rays and radium. This group is subdivided into clinic and private patients. In the other group the parametrium was treated with radiogold injected transvaginally, and the cervix was treated either by radium or by Wertheim hysterectomy, or by both radium and hysterectomy. In all patients operated upon a fairly extensive pelvic lymphadenectomy was done at the time of the hysterectomy. The two to four and one-half year survival rate of patients with Stage I lesions was 91.4 per cent in the series treated with radiogold, 78.1 per cent in the series of private patients treated with x-ray and radium, and 72 per cent in the clinic patients treated with x-ray and radium. The one-half to four and one-half year survivals were 92.1 per cent, 80.4 per cent, and 68.8 per cent, respectively. Not many patients with Stage II lesions were treated with radiogold in the first two years of the study. Eight out of nine patients (88.8 per cent), however, with Stage II lesions more than two years ago are alive and well. The one-half to four and one-half year survival rate for patients with Stage II lesions was 89.3 per cent in the series treated with radiogold, 56.5 per cent in the series of private patients treated with x-ray and radium, and 48.1 per cent in the series of clinic patients treated with x-ray and radium. There were 11 patients among the 70 subjected to radical operation in whom the lymph nodes were positive. Nine of these patients are alive and apparently free of disease. The incidence of positive nodes in Stage I cases operated upon was 9.8 per cent and in Stage II cases, 31.5 per cent. In the group of 70 patients subjected to operation, one patient developed a ureterovaginal fistula, one a ureterorectovaginal fistula, and one a vesicovaginal fistula. The study also has shown that a dosage of 8,000 to 10,000 r is necessary to destroy epidermoid cancer in the cervix itself.

Recollections of my Life with Progesterone

This paper gives in narrative style those phases of the corpus luteum story in which the author was an active participant. The first part deals with the exciting days at the University of Rochester wh

The effect of progesterone in adolescent girls and young women with functional uterine bleeding

Abstract The detailed menstrual records of 24 adolescent girls and young women with functional uterine bleeding are given. These subjects were given progesterone or anhydrohydroxy progesterone, and the effect on the menstrual pattern was observed over a period of many months in most cases. In general, the administration of approximately 30 mg. of progesterone was followed by cessation of bleeding within ten days of the last injection. Progesterone deprivation bleeding occurred frequently, thereby explaining the bleeding occurring in the first few days after therapy. In about one-third of the observations, normal cycles occurred for four months or more after therapy, whereas in another third there was a recurrence in less than four months. Even in these, however, there was no recurrence in the first month. In the final third of the observations, amenorrhea followed immediately or after two or three cycles.

Radiogold in the treatment of cancer of the cervix.

The main objective in the use of radioactive colloidal gold for the treatment of cancer of the cervix is safe, adequate, and convenient irradiation of the pelvic lymph nodes. This is in no way different from the motive behind the use of conventional x-rays, supervoltage x-rays, or the gamma rays of radium or cobalt. The treatment of the primary lesion is no problem. Supplemental therapy is necessary, however, because some patients undoubtedly have cancer in the pelvic lymph nodes which would not be destroyed by direct irradiation of the cervix or by hysterectomy. Radiogold is only an agent for providing supplemental therapy. The properties of radiogold are nearly ideal for this purpose. The short half-life of 2.8 days limits the duration of irradiation. The radioactivity is primarily beta, so that the majority of the effect is restricted to the immediate vicinity of the interstitial injection. Radiogold, however, is especially valuable because of the manner in which the tissues absorb and “fix” the gold. ...

Chronic Uterine Distention in Progestin-Treated Rabbits.†

Summary Chronic uterine distention in oestrin-treated rabbits results in a reduction of the capacity of the uterus to grow in response to the stimulus of distention.

Inhibition of Menstruation by Crystalline Progesterone

It has been shown 1 that partially purified extracts of the corpus luteum, containing progesterone, possess the property of inhibiting menstruation in the monkey. In view of the possibility that contaminating substances were involved in this result, the experiments have been repeated on five animals with crystalline progesterone, both natural and synthetic. The hormones used consisted of 2 lots of β-progesterone prepared in our laboratory from sows ovaries, 2 lots of synthetic β-progesterone donated by the Schering Corporation through the kindness of Dr. Erwin Schwenk, and a lot of synthetic α-progesterone donated by E. Merck, Darmstadt. The animals were chosen and the experiments conducted in the same way as those of Corner, 1935. 1 Each animal was allowed one or more control cycles and the time of the next menses having been estimated as closely as possible from the history, treatment with progesterone was begun about a week before the expected onset. The dosage was uniformly 1 mg. daily, equivalent to 1 international unit. One animal received natural β-progesterone throughout. Two received the first of the Schering preparations for 11 days, and then the second Schering preparation for 5 and 6 days respectively; menstruation then being overdue, the experiments were continued with natural progesterone for a few days longer. Finally, 2 received the Merck α-progesterone throughout. In all 5 experiments, the expected menstruation was delayed for about 2 weeks, after which the hormone was discontinued according to plan. Bleeding began 2 to 4 days thereafter. The only feature in which the result with crystalline progesterone differed from that with the partially purified substance used in previous experiments, was in the more rapid onset of bleeding after discontinuance, namely 2 to 4 days instead of 5 to 8. This may have been due to more rapid utilization or excretion of the pure hormone. In conclusion, it may be stated that all 4 of the definitely established effects of corpus luteum extracts upon the uterus, namely progestational proliferation of the endometrium, 2 inhibition of action of pituitrin upon the myometrium, 3 inhibition of uterine motility in vivo, 4 and suppression of menstruation, 1 have now been achieved with crystalline progesterone.

Nomenclature of Corpus Luteum Hormone

DURING the past year, the progestational harmone has been isolated from the corpus luteum in pure form and its constitution established. Heretofore, two different names have been used in the literature for this hormone (progestin, luteosterone). For the sake of international uniformity, we agree to use hereafter in the scientific literature only the name progesterone for the pure hormone. As is known, the pure harmone exists in two different forms, one melting at 128° (uncorr.) and the other at 121° (uncorr.). The higher melting form (Compound B of Wintersteiner and Allen1 and Compound C of Slotta, Ruschig and Fels2) will be known as α-progesterone, and the lower melting form (Compound C of Wintersteiner and Allen and Compound D of Slotta, Ruschig and Fels) as β-progesterone. We hope that these names will be generally accepted in the scientific literature.