C HIARI in 1855 reported two cases of a syndrome which has occurred very rarely. It consists of amenorrhea with persistent lactation following delivery. In 1882 Frommel found one case in a study of 3?000 gynecological patients in Vienna. Sharpe’ in 1935 reviewed the literature, finding in all, four papers on the subject. AS the condition is so rare and as none of the reported cases had a subsequent pregnancy, the following case seems worth recording. Mrs. F. J., aged 32, was seen July 17, 1934. At the age of 23, an ovarian cyst was removed and an appendectomy done. In 1933, she was delivered by low forceps and episiotomy of a full-term baby girl weighing 8 pounds and 3 ounces, She did not menstruate following the delivery and her breasts continued to lactate. In 1.934, desiring another child, she was sent to me by Dr. Mac Naughton Wilkinson for study and to determine, if possible, the cause of the amenorrhea and lactating breasts. The physical examination was negative except that the breast ducts were full of secretion and the uterus was atrophic. Routine laboratory tests, including a basal metabolism, were negative. Endometrial biopsy revealed an atrophic endometrium. The endocrine preparations of that day were tried without relief. They were thyroid, progynon in oil, and corpus luteum extract. In 1941, the patient returned! stating that in 1940, her breasts had stopped secreting and her periods had returned. Her weight, 142 pounds was the same. The question was, could she become pregnant? Ho%vever, on January 20, 1942, Mrs. F. J. came to the office having missed two periods. Examination showed a pregnant uterus but the breasts were not secreting. On September 7, 1942, she was delivered of a g-pound baby girl by the Bell modification of the Scanzoni maneuver. She was unable to nurse the baby because of insufficient milk. To date, November 2, 1943, she has not menstruated and her breasts are dry. As far as I know, this is the only patient with Chiari’s syndrome who has had a subsequent pregnancy and delivery. An x-ray of the sella turcica and sugar tolerance test would have been interhsting, but there was nothing clinically to suggest difficulty in the pituitary gland.
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