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The Hormonal Cause of the So-Called Varicose Veins of Pregnancy

The Hormonal Cause of the So-Called Varicose Veins of Pregnancy Abstract Many aspects of superficial varicose veins of the lower extremities complicating pregnancy have been controversial.* The present study offers explanations for some of the controversies. The superficial venous disorders of the lower extremities during pregnancy have universally been identified as the classical superficial saphenous varicosities. We recently differentiated from the well-known saphenous varix a hitherto undescribed, completely different, superficial venous disorder which is limited to the pregnant state.1 We applied to it the term "angiectid." † A review of the literature indicated that the failure to differentiate the angiectid from the saphenous varix in the past was the cause for many of the controversies. This shortcoming is unexplainable because the two References 1. References 1 to 8. 2. Derivation of the new term, "angiectid": angi (Gr. angeion, a vessel); ect (Gr. ektasis, a stretching); id (Gr. idios, peculiar: in this instance, peculiar to pregnancy). We have limited this term to the intradermal vessel dilatation in the lower extremities of pregnant women, as described in this paper. 3. Specimens for estrogen and pregnanediol assays were collected on the same day. 4. Based on a single evaluation for estrogen. The titer was normal. 5. Five of the eight women had two to four assays of both hormones. All titers were subnormal. 6. Focal overdistentions with broken surfaces. 7. References 3, 5, and 13 to 25. 8. References 2, 4, 6, 8, and 26 to 42; Eastman, N. J., in discussion on Hamilton.3 9. References 4, 8, 26, 36, and 37. 10. References 6, 28, 36, and 37. 11. Provided by E. R. Squibb & Sons, New York, as Stilbetin. 12. Provided by the Schering Corporation, Bloomfield, N. J., as ethisterone (Pranone). 13. References 23, and 35. 14. References 7, 8, 23, 36, and 37. 15. References 43 and 45. 16. References 43 to 66. 17. References 44, 45, and 48 to 66. 18. References 46 and 47. 19. References 52, 62, and 66. 20. References 64, and 67 to 70. 21. References 47, 71, and 72. 22. References 46 and 74. 23. Refrences 74 to 79. 24. References 44, 45, 48, 49, 54, 55, 56, 62, 80, and 81. 25. References 58, 62, and 82; Smith, O. W., in discussion on Page.84 26. Fried, P. H.; Perilstein, P. K., and Wagner, F. B., Jr.: Saphenous Varicosities vs. Angiectids: Considerations of So-Called Varicose Veins of the Lower Extremities Complicating Pregnancy , Obst. & Gynec. 2:418-426 ( (Oct.) ) 1953. 27. Mendelsohn, S. N.: Varicose Veins Complicating Pregnancy: A Review of Recent Literature and an Appraisal of Current Therapy , Ohio M. J. 47:41-43 ( (Jan.) ) 1951. 28. Hamilton, H. G.; Pittam, R. F., and Higgins, R. S.: Active Therapy of Varicose Veins in Pregnancy , South. M. J. 42:608-612 ( (July) ) 1949. 29. Siegler, J.: The Treatment of Varicose Veins in Pregnancy , Am. J. Surg. 44:403-408 ( (May) ) 1939. 30. Dodd, H.: Operation for Severe Varicose Veins During Pregnancy , Lancet 1:606-607 ( (April 9) ) 1949. 31. Fields, A.: Varicose Veins: Current Therapy , Ann. West. Med. & Surg. 4:738-743 ( (Nov.) ) 1950. 32. King, E. S. J.: The Genesis of Varicose Veins , Australian & New Zealand J. Surg. 20:126-133 ( (Nov.) ) 1950. 33. Zambonini, A.: The Venous System and the Puerperal State , Riv. ital. ginec. 30:135-137 ( (Aug.) ) 1947. 34. Rakoff, A. E.: An Improved Procedure for Biological Titration of Estrogenic Hormone in Sera of Pregnant Women , Proc. Soc. Exper. Biol. & Med. 40:195-196 ( (July) ) 1939. 35. Fried, P. H., and Rakoff, A. E.: A Rapid Chorionic Gonadotropin Assay Method for Clinical Purposes , J. Clin. Endocrinol. 12:953 ( (July) ) 1952. 36. Sommerville, I. F.; Gough, N., and Marrian, G. F.: The Quantitative Determination of Small Amounts of Pregnanediol in Human Urine , J. Endocrinol. 5:247-257 ( (Jan.) ) 1948. 37. Rakoff, A. E., and Gross, M.: Clearance of Potassium Estrone Sulfate from the Blood Following Intravenous Injection , Fed. Proc. 10:107 ( (March) ) 1951. 38. Mullane, D. J.: Varicose Veins in Pregnancy , Am. J. Obst. & Gynec. 63:620-626 ( (March) ) 1952. 39. Sullivan, J. M.: Varicose Veins in Pregnancy , Wisconsin M. J. 49:291-296 ( (April) ) 1950. 40. Peyton, F. W., and Loop, F. A.: Saphenous Phlebectomy for Varicose Veins During Pregnancy , Am. J. Obst. & Gynec. 58:318-325 ( (Aug.) ) 1949. 41. Shank, P. J.: Treatment of Varicose Veins During Pregnancy by Combined high Saphenous and Segmental Ligations Followed by the Injection of Residual Varicosities , Ohio M. J. 44:477-481 ( (May) ) 1948. 42. Kimmel, M. L.: Practical Approach to the Treatment of Varicose Veins in Pregnancy , Bull. Margaret Hague Matern. Hosp. ( (Sept.) ) 1952. 43. Titus, P.: Management of Obstetrical Difficulties , Ed. 1, St. Louis, C. V. Mosby Company, 1940, p. 130. 44. DeLee, J. B., and Greenhill, J. P.: Principles and Practice of Obstetrics , Ed. 9, Philadelphia, W. B. Saunders Company, 1947. 45. Varicose Veins in Pregnancy, Editorial , West. J. Surg. 58:587-589 ( (Oct.) ) 1950. 46. Greenhill, J. P.: Symposium on Gynecology and Obstetrics: Treatment of Surgical Complications During Pregnancy , S. Clin. North America 30:175-190 ( (Feb.) ) 1950. 47. Greenhill, J. P.: Management in Obstetric Complications , C. P. Lull, Editor, Ed. 1, Philadelphia, J. B. Lippincott Company, 1945, p. 135. 48. McCausland, A. M.: Varicose Veins in Pregnancy , California & West. Med. 50:1-15 ( (April) ) 1939. 49. de Takats, G.: Obstetrics and Gynecology , A. H. Curtis, Editor, Ed. 1, Philadelphia, W. B. Saunders Company, 1934, Vol. 1, p. 695. 50. Danforth, W. C.: Obstetrics and Gynecology , A. H. Curtis, Editor, Philadelphia, W. B. Saunders Company, 1933, Vol. 1, pp. 695, 697, and 724. 51. Foote, R.: Varicose Veins , Ed. 1, St. Louis, C. V. Mosby Company, 1949, pp. 39, 41, 43, 72, 112-114, 209-210. 52. Sherman, R. S.: Varicose Veins: Further Findings Based on Anatomic and Surgical Dissections , Ann. Surg. 130:218-232 ( (Aug.) ) 1949. 53. McPheeters, H. O.: Saphenofemoral Ligation with Immediate Retrograde Injection , Surg. Gynec. & Obst. 81:355-364 ( (Oct.) ) 1945. 54. Wright, I. S.: Vascular Diseases in Clinical Practice , Chicago, The Year Book Publishers, Inc., 1948, pp. 429-437. 55. Pratt, G. H.: Surgical Management of Vascular Diseases , Philadelphia, Lea & Febiger, 1949. 56. Zax, E.: Terminal Saphenous Resection , Texas J. Med. 41:307-309 ( (Oct.) ) 1945. 57. Veal, J. R., and Hussey, H. H.: Venous Circulation in Lower Extremities During Pregnancy , Surg. Gynec. & Obst. 72:841-847 ( (May) ) 1941. 58. Bland, P. B., and Montgomery, T. L.: Practical Obstetrics , Ed. 3, Philadelphia, F. A. Davis Company, 1939, pp. 173-174 and 223. 59. Mengert, W. F.: Postgraduate Obstetrics , Ed. 1, New York, Paul B. Hoeber, Inc., 1947, pp. 32-33. 60. McCausland, A. M.: The Influence of Hormones upon Varicose Veins in Pregnancy , West. J. Surg. 51:199-200 ( (May) ) 1943. 61. McPheeters, H. O.: The Value of Estrogen Therapy in the Treatment of Varicose Veins Complicating Pregnancy , Journal Lancet 69:2-4 ( (Jan.) ) 1949. 62. Vaux, M. W.: Edgar's Practice of Obstetrics , Ed. 6, Philadelphia, Blakiston Company, 1926, pp. 207-208. 63. Solomons, B.: Tweedy's Practical Obstetrics , Ed. 6, New York, Humphrey Mulford, Oxford University Press, 1929, pp. 220-221. 64. Polak, J. O.: Manual of Obstetrics , New York, Physicians & Surgeons Book Co., 1922, pp. 277-278. 65. Stander, H. J.: Williams' Obstetrics , Ed. 7, New York, Appleton-Century-Crofts, Inc., 1936, pp. 663, 787, 1218. 66. Scott, W. A., and Van Wyck, H. B.: The Essentials of Obstetrics and Gynecology , Ed. 1, Philadelphia, Lea & Febiger, 1946, p. 160. 67. Barrow, D. W.: The Clinical Management of Varicose Veins , Ed. 1, New York, Paul B. Hoeber, Inc., 1948, p. 138. 68. Freed, S. C., and Linder: The Effects of Steroids of the Adrenal Cortex and Ovary on Capillary Permeability , Am. J. Physiol. 134:258-262 ( (Sept.) ) 1941. 69. Loeser, A. A.: Action of Intravenously Injected Sex Hormones and Other Substances on the Blood Flow in the Human Endometrium , J. Obst. & Gynec. Brit. Emp. 55:17-22 ( (Feb.) ) 1948. 70. Williams, M. F.: The Vascular Architecture of the Rat Uterus As Influenced by Estrogen and Progesterone , Am. J. Anat. 83:247-307 ( (Sept.) ) 1948. 71. McGrath, E. J., and Hernmann, L. G.: Influence of Estrogens on Peripheral Vasomotor Mechanism , Ann. Surg. 120:607-616 ( (Oct.) ) 1944. 72. McGrath, E. J. G.: Experimental Peripheral Gangrene: Effect of Estrogenic Substance in Its Relation to Thrombo-Angiitis Obliterans , Arch. Int. Med. 55:942-957 ( (June) ) 1935. 73. Kaiser, I. H.: The Effect of Atropine and Estrogens on the Intraocular Uterine Transplants in the Rabbit , Bull. Johns Hopkins Hosp. 82:429-445 ( (April) ) 1948. 74. Fagin, J., and Reynolds, S. R. M.: The Endometrial Vascular Bed in Relation to Rythmic Uterine Motility, with a Consideration of the Functions of the Intermittent Contractions of Oestrus , Am. J. Physiol. 117:86-91 ( (Sept.) ) 1936. 75. Reynolds, S. R. M., and Foster, F. I.: Peripheral Vascular Action of Estrogen , J. Pharmacol. & Exper. Therap. 68:173-184 ( (Jan.) ) 1940. 76. Carloni, E.: L'azione degli estratti ovarici sull' atteggiamento dei capillari e sulla loro pressione nelle varie fasi—della revoluzione funziozionale utero-ovarica , Arch. ostet. e ginec. 17:327-407 ( (June) ) 1930. 77. Reynolds, S. R. M., and Foster, F. I.: Peripheral Vascular Action of Estrogen in Human Male , J. Clin. Invest. 18:649-655 ( (Nov.) ) 1939. 78. Mortimer, H.; Wright, P.; Bachman, C., and Collip, J. B.: The Effects of Administration of Oestrogenic Hormones on the Nasal Mucosa of the Monkey , Proc. Soc. Exper. Biol. & Med. 34:535-538 ( (May) ) 1936. 79. Reynolds, S. R. M., and Foster F. I.: Acetylcholine Equivalent Content of the Nasal Mucosa in Rabbits and Cats, Before and After Administration of Estrogens , Am. J. Physiol. 131:422-425 ( (Dec.) ) 1940. 80. Jacobsen, E. M.: Response of Intraocular Endometrial Implants to Estrogens , Endocrinology 44:367-388 ( (June) ) 1944. 81. MacLeod, J., and Reynolds, S. R. M.: Vascular, Metabolic and Mobility Responses of Uterine Tissues Following Administration of Oestrin , Proc. Soc. Exper. Biol. & Med. 37:666-668 ( (Jan.) ) 1938. 82. Reynolds, S. R. M.: The Cholinergic Action of Oestron , Science 87:537 ( (June 10) ) 1938. 83. Reynolds, S. R. M.; Kaminester, S.; Foster, F. I., and Schloss, S.: Dermovascular Effects of Estrogens in Women with Menopausal Flashes , Surg. Gynec. & Obst. 73:206-211 ( (Aug.) ) 1941. 84. Reynolds, S. R. M.; Hamilton, J. B.; DiPalma, J. R.; Hubert, G. R., and Foster, F. I.: Dermavascular Action of Certain Steroid Hormones in Castrate, Eunuchoid, and Normal Men , J. Clin. Endocrinol. 2:228-236 ( (April) ) 1942. 85. Mortimer, H.; Wright, P., and Collip, J. B.: The Effect of Oestrogenic Hormones on the Nasal Mucosa , Canad. M. A. J. 35:615-621 ( (Dec.) ) 1936. 86. Reynolds, S. R. M.: Acetylcholine Content of Uteri Before and After Administration of Oestrin to Ovariectomized Rabbits , J. Physiol. 95:258-268 ( (March 14) ) 1939. 87. Reynolds, S. R. M.: Physiology of the Uterus , Ed. 2, New York, Paul B. Hoeber, Inc., 1949, pp. 194, 295, 298, 301, 314-317. 88. Reynolds, S. R. M., and Foster, F. I.: Relative Cholinergic Effects of Selected Estrogens , Am. J. Physiol. 128:147-153 ( (Dec.) ) 1939. 89. Bean, W. B.: A Note on the Development of Cutaneous Arterial "Spiders" and Palmar Erythema , Am. J. M. Sc. 204:251-253 ( (Aug.) ) 1942. 90. Bean, W. B.: Cutaneous Arterial Spider , Medicine 24:243-331 ( (Sept.) ) 1945. 91. Mackenzie, J. N.: Irritation of the Sexual Apparatus as an Etiological Factor in the Production of Nasal Disease , Am. J. M. Sc. 87:630, 1884. 92. Blankenhorn, M. A., and Bean, W. B.: Vascular Spiders , Tr. A. Am. Physicians 61:76-80 ( (July) ) 1948. 93. Bean, W. B.; Cogswell, R. C.; Dexter, M., and Embick, J. F.: Vascular Changes of the Skin in Pregnancy: Vascular Spiders and Palmar Erythema , Surg. Gynec. & Obst. 88:739-752 ( (June) ) 1949. 94. Walsh, E. N., and Becker, S. W.: Erythema Palmare and Naevus-Araneus-like Telangiectases , Arch. Dermat. & Syph. 44:616-630 ( (Oct.) ) 1941. 95. Pincus, I. J.; Rakoff, A. E.; Cohn, E. M., and Tumen, H. J.: Hormonal Studies in Patients with Chronic Liver Disease , Gastroenterology 19:735-754 ( (Dec.) ) 1951. 96. McGrath, E. J.: Experimental Peripheral Gangrene , J. A. M. A. 105:854-856 ( (Sept. 14) ) 1935. 97. Suzman, M. M.; Freed, C. C., and Prag, J. J.: Studies on Experimental Peripheral Vascular Disease with Special Reference to Thromboangitans Obliterans , South African J. M. Sc. 3:29-39 ( (Jan.) ) 1938. 98. Herrmann, L. G., and McGrath, E. J.: Effect of Estrogens on Vascular Spasm Due to Active Angitis in the Extremities , Arch. Surg. 40:334-343 ( (Feb.) ) 1940. 99. Taylor, C., and Walker, J.: Use of Testosterone Propionate and Estrogenic Substance in the Treatment of Essential Hypertension, Angina Pectoris, and Peripheral Vascular Diseases , J. Clin. Endocrinol. 2:560-568 ( (Sept.) ) 1942. 100. Shaefer, R. L.: Menopausal Hypertension , Endocrinology 19:705-709 ( (May) ) 1935. 101. Koch, H. J., Jr.; Escher, G. C., and Lewis, J. S.: Hormonal Management of Hereditary Hemorrhagic Telangiectasia , J. A. M. A. 149:1376-1380 ( (Aug. 9) ) 1952. 102. Scherf, D.: The Respiratory and the Circulatory System in Females with Ovarian Dysfunction , Ann. Int. Med. 13:1414-1430 ( (Feb.) ) 1940. 103. Scherf, D., and McGavack, T. H.: The Estrogen-Like Action of Desoxycorticosterone Acetate upon the Altered Electrocardiogram Seen in Various Hypo-Ovarian States , Am. J. M. Sc. 204:41-52 ( (July) ) 1942. 104. Nelson, R. L.: The Treatment of Hypogonadal Types of Cardiovascular Imbalance , Tr. Am. Therap. Soc. 30:49-52 ( (Jan.) ) 1940. 105. Markee, J. E.: The Morphologic and Endocrine Basis for Menstrual Bleeding , in Progress in Gynecology , Vol. 1, J. V. Meigs, and S. H. Sturgis, Editors, New York, Grune & Stratton, Inc., 1946, pp. 37-47. 106. Markee, J. E., and Berg, B.: Cyclic Fluctuations in Blood Estrogen as a Possible Cause of Menstruation , Stanford M. Bull. 2:55-60 ( (July) ) 1955. 107. Hirst, D. V.; Hamblen, E. C., and Cuyler, W. K.: Rationale of Estrogenic Therapy in Functional Dysmenorrhea , J. Clin. Endocrinol. 2:442-446 ( (July) ) 1942.Crossref 108. Smith, O. W.: Diethylstilbestrol in the Prevention and Treatment of Complications of Pregnancy , Am. J. Obst. & Gynec. 56:821-834 ( (Nov.) ) 1948. 109. Page, E. W.: Placental Dysfunction in Eclamptogenic Toxemias , Obst. & Gynec. Surv. 3:615-638 ( (Oct.) ) 1948. 110. Duguid, J. B.: The Etiology and Pathogenesis of Varicose Veins , Practitioner 166:223-227 ( (March) ) 1951. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

The Hormonal Cause of the So-Called Varicose Veins of Pregnancy

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American Medical Association
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Copyright © 1956 American Medical Association. All Rights Reserved.
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0096-6908
DOI
10.1001/archsurg.1956.01270200069013
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Abstract

Abstract Many aspects of superficial varicose veins of the lower extremities complicating pregnancy have been controversial.* The present study offers explanations for some of the controversies. The superficial venous disorders of the lower extremities during pregnancy have universally been identified as the classical superficial saphenous varicosities. We recently differentiated from the well-known saphenous varix a hitherto undescribed, completely different, superficial venous disorder which is limited to the pregnant state.1 We applied to it the term "angiectid." † A review of the literature indicated that the failure to differentiate the angiectid from the saphenous varix in the past was the cause for many of the controversies. This shortcoming is unexplainable because the two References 1. References 1 to 8. 2. Derivation of the new term, "angiectid": angi (Gr. angeion, a vessel); ect (Gr. ektasis, a stretching); id (Gr. idios, peculiar: in this instance, peculiar to pregnancy). We have limited this term to the intradermal vessel dilatation in the lower extremities of pregnant women, as described in this paper. 3. Specimens for estrogen and pregnanediol assays were collected on the same day. 4. Based on a single evaluation for estrogen. The titer was normal. 5. Five of the eight women had two to four assays of both hormones. All titers were subnormal. 6. Focal overdistentions with broken surfaces. 7. References 3, 5, and 13 to 25. 8. References 2, 4, 6, 8, and 26 to 42; Eastman, N. J., in discussion on Hamilton.3 9. References 4, 8, 26, 36, and 37. 10. References 6, 28, 36, and 37. 11. Provided by E. R. Squibb & Sons, New York, as Stilbetin. 12. Provided by the Schering Corporation, Bloomfield, N. J., as ethisterone (Pranone). 13. References 23, and 35. 14. References 7, 8, 23, 36, and 37. 15. References 43 and 45. 16. References 43 to 66. 17. References 44, 45, and 48 to 66. 18. References 46 and 47. 19. References 52, 62, and 66. 20. References 64, and 67 to 70. 21. References 47, 71, and 72. 22. References 46 and 74. 23. Refrences 74 to 79. 24. References 44, 45, 48, 49, 54, 55, 56, 62, 80, and 81. 25. References 58, 62, and 82; Smith, O. W., in discussion on Page.84 26. Fried, P. H.; Perilstein, P. K., and Wagner, F. B., Jr.: Saphenous Varicosities vs. Angiectids: Considerations of So-Called Varicose Veins of the Lower Extremities Complicating Pregnancy , Obst. & Gynec. 2:418-426 ( (Oct.) ) 1953. 27. Mendelsohn, S. N.: Varicose Veins Complicating Pregnancy: A Review of Recent Literature and an Appraisal of Current Therapy , Ohio M. J. 47:41-43 ( (Jan.) ) 1951. 28. Hamilton, H. G.; Pittam, R. F., and Higgins, R. S.: Active Therapy of Varicose Veins in Pregnancy , South. M. J. 42:608-612 ( (July) ) 1949. 29. Siegler, J.: The Treatment of Varicose Veins in Pregnancy , Am. J. Surg. 44:403-408 ( (May) ) 1939. 30. Dodd, H.: Operation for Severe Varicose Veins During Pregnancy , Lancet 1:606-607 ( (April 9) ) 1949. 31. Fields, A.: Varicose Veins: Current Therapy , Ann. West. Med. & Surg. 4:738-743 ( (Nov.) ) 1950. 32. King, E. S. J.: The Genesis of Varicose Veins , Australian & New Zealand J. Surg. 20:126-133 ( (Nov.) ) 1950. 33. Zambonini, A.: The Venous System and the Puerperal State , Riv. ital. ginec. 30:135-137 ( (Aug.) ) 1947. 34. Rakoff, A. E.: An Improved Procedure for Biological Titration of Estrogenic Hormone in Sera of Pregnant Women , Proc. Soc. Exper. Biol. & Med. 40:195-196 ( (July) ) 1939. 35. Fried, P. H., and Rakoff, A. E.: A Rapid Chorionic Gonadotropin Assay Method for Clinical Purposes , J. Clin. Endocrinol. 12:953 ( (July) ) 1952. 36. Sommerville, I. F.; Gough, N., and Marrian, G. F.: The Quantitative Determination of Small Amounts of Pregnanediol in Human Urine , J. Endocrinol. 5:247-257 ( (Jan.) ) 1948. 37. Rakoff, A. E., and Gross, M.: Clearance of Potassium Estrone Sulfate from the Blood Following Intravenous Injection , Fed. Proc. 10:107 ( (March) ) 1951. 38. Mullane, D. J.: Varicose Veins in Pregnancy , Am. J. Obst. & Gynec. 63:620-626 ( (March) ) 1952. 39. Sullivan, J. M.: Varicose Veins in Pregnancy , Wisconsin M. J. 49:291-296 ( (April) ) 1950. 40. Peyton, F. W., and Loop, F. A.: Saphenous Phlebectomy for Varicose Veins During Pregnancy , Am. J. Obst. & Gynec. 58:318-325 ( (Aug.) ) 1949. 41. Shank, P. J.: Treatment of Varicose Veins During Pregnancy by Combined high Saphenous and Segmental Ligations Followed by the Injection of Residual Varicosities , Ohio M. J. 44:477-481 ( (May) ) 1948. 42. Kimmel, M. L.: Practical Approach to the Treatment of Varicose Veins in Pregnancy , Bull. Margaret Hague Matern. Hosp. ( (Sept.) ) 1952. 43. Titus, P.: Management of Obstetrical Difficulties , Ed. 1, St. Louis, C. V. Mosby Company, 1940, p. 130. 44. DeLee, J. B., and Greenhill, J. P.: Principles and Practice of Obstetrics , Ed. 9, Philadelphia, W. B. Saunders Company, 1947. 45. Varicose Veins in Pregnancy, Editorial , West. J. Surg. 58:587-589 ( (Oct.) ) 1950. 46. Greenhill, J. P.: Symposium on Gynecology and Obstetrics: Treatment of Surgical Complications During Pregnancy , S. Clin. North America 30:175-190 ( (Feb.) ) 1950. 47. Greenhill, J. P.: Management in Obstetric Complications , C. P. Lull, Editor, Ed. 1, Philadelphia, J. B. Lippincott Company, 1945, p. 135. 48. McCausland, A. M.: Varicose Veins in Pregnancy , California & West. Med. 50:1-15 ( (April) ) 1939. 49. de Takats, G.: Obstetrics and Gynecology , A. H. Curtis, Editor, Ed. 1, Philadelphia, W. B. Saunders Company, 1934, Vol. 1, p. 695. 50. Danforth, W. C.: Obstetrics and Gynecology , A. H. Curtis, Editor, Philadelphia, W. B. Saunders Company, 1933, Vol. 1, pp. 695, 697, and 724. 51. Foote, R.: Varicose Veins , Ed. 1, St. Louis, C. V. Mosby Company, 1949, pp. 39, 41, 43, 72, 112-114, 209-210. 52. Sherman, R. S.: Varicose Veins: Further Findings Based on Anatomic and Surgical Dissections , Ann. Surg. 130:218-232 ( (Aug.) ) 1949. 53. McPheeters, H. O.: Saphenofemoral Ligation with Immediate Retrograde Injection , Surg. Gynec. & Obst. 81:355-364 ( (Oct.) ) 1945. 54. Wright, I. S.: Vascular Diseases in Clinical Practice , Chicago, The Year Book Publishers, Inc., 1948, pp. 429-437. 55. Pratt, G. H.: Surgical Management of Vascular Diseases , Philadelphia, Lea & Febiger, 1949. 56. Zax, E.: Terminal Saphenous Resection , Texas J. Med. 41:307-309 ( (Oct.) ) 1945. 57. Veal, J. R., and Hussey, H. H.: Venous Circulation in Lower Extremities During Pregnancy , Surg. Gynec. & Obst. 72:841-847 ( (May) ) 1941. 58. Bland, P. B., and Montgomery, T. L.: Practical Obstetrics , Ed. 3, Philadelphia, F. A. Davis Company, 1939, pp. 173-174 and 223. 59. Mengert, W. F.: Postgraduate Obstetrics , Ed. 1, New York, Paul B. Hoeber, Inc., 1947, pp. 32-33. 60. McCausland, A. M.: The Influence of Hormones upon Varicose Veins in Pregnancy , West. J. Surg. 51:199-200 ( (May) ) 1943. 61. McPheeters, H. O.: The Value of Estrogen Therapy in the Treatment of Varicose Veins Complicating Pregnancy , Journal Lancet 69:2-4 ( (Jan.) ) 1949. 62. Vaux, M. W.: Edgar's Practice of Obstetrics , Ed. 6, Philadelphia, Blakiston Company, 1926, pp. 207-208. 63. Solomons, B.: Tweedy's Practical Obstetrics , Ed. 6, New York, Humphrey Mulford, Oxford University Press, 1929, pp. 220-221. 64. Polak, J. O.: Manual of Obstetrics , New York, Physicians & Surgeons Book Co., 1922, pp. 277-278. 65. Stander, H. J.: Williams' Obstetrics , Ed. 7, New York, Appleton-Century-Crofts, Inc., 1936, pp. 663, 787, 1218. 66. Scott, W. A., and Van Wyck, H. B.: The Essentials of Obstetrics and Gynecology , Ed. 1, Philadelphia, Lea & Febiger, 1946, p. 160. 67. Barrow, D. W.: The Clinical Management of Varicose Veins , Ed. 1, New York, Paul B. Hoeber, Inc., 1948, p. 138. 68. Freed, S. C., and Linder: The Effects of Steroids of the Adrenal Cortex and Ovary on Capillary Permeability , Am. J. Physiol. 134:258-262 ( (Sept.) ) 1941. 69. Loeser, A. A.: Action of Intravenously Injected Sex Hormones and Other Substances on the Blood Flow in the Human Endometrium , J. Obst. & Gynec. Brit. Emp. 55:17-22 ( (Feb.) ) 1948. 70. Williams, M. F.: The Vascular Architecture of the Rat Uterus As Influenced by Estrogen and Progesterone , Am. J. Anat. 83:247-307 ( (Sept.) ) 1948. 71. McGrath, E. J., and Hernmann, L. G.: Influence of Estrogens on Peripheral Vasomotor Mechanism , Ann. Surg. 120:607-616 ( (Oct.) ) 1944. 72. McGrath, E. J. G.: Experimental Peripheral Gangrene: Effect of Estrogenic Substance in Its Relation to Thrombo-Angiitis Obliterans , Arch. Int. Med. 55:942-957 ( (June) ) 1935. 73. Kaiser, I. H.: The Effect of Atropine and Estrogens on the Intraocular Uterine Transplants in the Rabbit , Bull. Johns Hopkins Hosp. 82:429-445 ( (April) ) 1948. 74. Fagin, J., and Reynolds, S. R. 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Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Feb 1, 1956

References

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