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Full text of "Action of Ovarian Lipoids upon the Genital System"

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308 


PROGRESS OF MEDICAL SCIENCE 


a cause of the tumors, but that it likewise is a result of the disturbed 
ovarian function, as is the marked delay and irregularity in the onset 
of the menopause, which is often seen in these cases. 


Dissection of the Ureter in the Radical Operation for Uterine Car¬ 
cinoma. — Mayer (Zeitschr. f. Geb. u. Gyn., 1914, lxxv, 399) says that 
while in many eases the ureter is easily found by the process of separa¬ 
ting from above the layers of the broad ligament, in occasional instances 
this becomes very difficult, especially in the presence of senile or inflamed 
tissues. Moreover, at times numerous branching veins are present 
throughout the whole of the broad ligament, and give rise to exceedingly 
annoying hemorrhage as they are ruptured in separating the layers. 
In such cases, he has found the following slight modification of the 
usual technique of great service: The ureter can almost always be 
distinctly seen shining through its peritoneal covering in the higher 
portion of the posterior pelvic wall, or at the point where it crosses the 
great vessels. If the operator, after severing the round ligament and 
adnexa, draws the uterus forcibly forward and to the opposite side, 
before any dissection has been done to disturb the natural relations, it 
is always easy to trace the ureter down by sight to its point of entrance 
into the parametrium. If a small longitudinal incision be made in the 
peritoneum at this point, immediately over the ureter, the latter will 
be exposed without having separated any of the tissues of the broad 
ligament, and therefore without the production of any hemorrhage. If 
now the ureter is lifted by means of a long blunt hook, or similar instru¬ 
ment, to one side or the other, the entire posterior layer of the broad 
ligament can be cut through low down, exposing the uterine artery and 
ureter in their entire course through the ligament, without the necessity 
for any blunt dissection of tissue. By this means, it is possible to remove 
a larger amount of paremetrium than by the usual methods, and the 
uterine artery is easily exposed for ligation, without any danger to the 
ureter. 


Action of Ovarian Lipoids upon the Genital System. —An interest¬ 
ing report has recently been made by Iscovesco (Rev. de gyn. et de chir., 
abdom., 1914, xxii, 161) upon some experimental and clinical studies 
of certain lipoids obtained from human ovaries. As Iscovesco points 
out, every gland of internal secretion throws into the circulation a 
number of different lipoidal substances, one of which appears to have 
the specifib action of stimulating the secretory activity of the gland 
itself. Fresh human ovary was found to contain about 3 per cent, by 
weight of total lipoids; extracting these by means of ether, acetone, 
chloroform, alcohol, etc., Iscovesco was able to distinguish five main 
groups, of which the fifth, or alcohol-soluble group is much the most 
important. By further solution and precipitation, this group can be 
subdivided into several different constituents, one of which, called by 
Iscovesco VDc, appears to exert a marked stimulant acting upon the 
ovary and whole genital system. It is a yellowish, wax-like substance; 
which for experimental and clinical use was made up in a 2 per cent, 
solution in oil. This solution may be injected hypodermically or 
intraperitoneally into laboratory animals, without any signs of irri¬ 
tation or infection, A series of young rabbits injected daily, or at inter- 



DERMATOLOGY 


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vals of a few days, for a considerable period of time, all showed when 
killed and autopsied an enlargement of the ovaries and uterus to two 
or three times the size of these organs in controls; very young animals, 
in whom the injections were started at the sixth week and continued 
until the fifteenth week, showed by that time genital organs exceeding 
in size and weight those of adult animals. Practically no effect was 
produced in any of the experiments on any of the other organs, except 
the thyroid, which showed in the injected animals a slight increase 
in size; the effect here was much less, however, than in the genital 
tract. Iscovesco thinks the substance acts by direct stimulation of 
the genital centres in the central nervous system. For therapeutic 
purposes the same oily solution was given in 1 c.c. doses by deep injec¬ 
tion into the gluteal muscles once daily, or four to six pills, each con¬ 
taining 2 cgm. of the lipoid, were given by mouth. The author reports 
astonishingly good results in the treatment of a number of cases of 
dysmenorrhea, amenorrhea due to ovarian hypofunction, and various 
nervous conditions in young girls, associated with irregular or painful 
menstruation, and probably having a basis in disturbed ovarian acti¬ 
vity. Equally good results were obtained from the treatment of a 
number of patients suffering from the results of a natural or artificial 
menopause. Iscovesco does not think that the corpus luteum is respon¬ 
sible for the secretion of any substance essentially different from that 
elaborated by the entire ovary; if there is any difference, it is merely 
that the active substances are present in the corpus luteum in greater 
concentration. He has isolated from the corpus luteum a lipoid pos¬ 
sessing identical chemical and physical characteristics with the one 
obtained from the ovary, and in a small number of animal experiments 
and therapeutic tests the results have been entirely similar. 


DERMATOLOGY 


UNDER THE CHARGE OF 

MILTON B. HARTZELL, M.D., 

PROFESSOR OF DERMATOLOGY IN THE UNIVERSITY OF PENNSYLVANIA. 


Disseminated Hematogenous Tuberculosis Verrucosa Cutis.— 

Bourgeois ( Dermatol. Zeitsch., Band xxi, Heft 1), who has made a 
most careful study of two cases of verrucose tuberculosis of the skin 
with multiple disseminated lesions, following, in the one instance 
measles, in the other scarlet fever, concludes that, besides the ordinary 
form which arises from local infection, there is a second, hematogenous 
in origin. The hematogenous form occurs chiefly in children with or 
without previous tuberculous symptoms, almost always after some 
one of the exanthemas, usually measles, much less frequently scarlet 
fever, and is not infrequently associated with other forms of cutaneous 
tuberculosis, such as the papulonecrotic tuberculide and lichen scro- 
fulosorum. Clinically and histologically the hematogenous variety