MARCH 28, 1959 MEDICAL MEMORANDA
viruses was obtained, the clinical picture throughout was
so typical that we cannot attribute the symptoms to
anything but Bornholm disease.
We thank Dr. Ian A. McGregor for permission to publish,
-and Dr. T. Langwell, superintendent of the Victoria
Hospital, Bathurst, for referring two of the cases to us. We
are grateful to Dr. K. E. K. Rowson, of the Central Public
Health Laboratory, Colindale, London, for performing the
serological tests.
R. D. FooRD, M.B., B.S.,
H. M. GILLES, M.D., B.Sc., D.T.M.&H.,
Medical Research Council Laboratores, Fajara, Gambia,
British West Africa.
REFERNCES
Colbourne, M. J. (1954). W. Afr. med. J., 3, 201.
Dalldorf. G. (1952). Poliomyelitis: Papers and Discussions
presented at the Second International Poliomyelitis Confer-
ence, 1951. p. 111.
Sylvest, E. (1934). Epidemic Myalgia. Oxford Univ. Press,
London.
Repeat Hydatidiform Mole, Presumed
Second Mole, Occurring within
Twelve Months
The incidence of hydatidiform mole has been estimated
as being between 1 in 2,500 (Novak, 1952) and I in 610
(Moore et al., 1957). The increased incidence in recent
years may be a true increase or may be due to a greater
amount of abortion material being examined. The
incidence of repeat mole is less easy to determine.
Brews (1939) found I repeat mole in a series of 100 cases
of hydatidiform mole; Chesley et al., (1946) found I in
57; Jeffreys and Graffagnino (1944) found 2 in 28.
Other cases have been reported by Mathieu (1937), Wall
and Hertig (1948), Jaikaran (1955), and Posner et al.
(1955). Repeat mole within one year of the first must
be extremely rare.
CASE REPORT
A married woman aged 33 was admitted to hospital on
July 22, 1955. Her previous health had been good. She
had had two previous pregnancies; the first, four years
previously, had been uneventful, ending in a normal
delivery at home; the second, two years later, had ended
in a spontaneous abortion at three months. Her last normal
menstrual period had been 12 weeks prior to admission. on
May 4. She had been perfectly well until 15 days before
admission, when sbe had had excessive vomiting. occurring
at any time of the day, and daily slight bleeding per
vaginam. She had also noticed that there had been a fairly
rapid increase in the size of her abdomen accompanied by
backache and generalized abdominal discomfort.
On admission she was pale; her blood pressure was
145/90, pulse 100, and temperature normal. The uterus
was enlarged to 2 in. (5 cm.) above the umbilicus. and was
tense and tender. X-ray examination failed to show foetal
parts. A Hogben test was reported as positive undiluted,
but not strong enough to warrant diluting. Vaginal
bleeding continued to be slight and the uterus to increase
in size. The haemoglobin fell to 30% (4.3 g./100 ml.), so
she was given 4 pints (2,160 ml.) of blood over the next two
days.
On August 8, 16 days after admission, she aborted a
hydatidiform mole which was estimated as 2 pints (1,080
ml.) of vesicles and 1 pint (540 ml.) of old blood. The
vesicles varied in size from 2 mm. to 2 cm. After this
she received a course of penicillin and sulphadimidine for
a low-grade pyrexia. On August 18, 10 days after aborting,
she was examined in the operating theatre under general
anaesthesia, and a thorough curettage was performed. The
uterus was firm and the cavity smooth. The right ovary
KBJRfL 835
was slightly enlarged and felt cystic. The curettings were
examined histologically and reported on as follows:
"Degenerated and infected decidua present; no chorionic
structures identified." A further Hogben test was reported
as negative, and. as her haemoglobin was now 610% (8.8 g./
100 ml.), she was discharged from hospital at the end of
August.
When seen in the out-patient department in September
she had had a normal period. The uterus was normal in
size and the right ovary only slightly enlarged. As the
Hogben test was reported as negative she was asked to
return to the clinic in early December. When she did so she
had had three normal periods, the last one being five
weeks previously. She did not think that she was pregnant,
although there was a possibility that she might be.
Examination was inconclusive. A JHogben test performed
during the next week was weakly positive undiluted. A
further specimen of urine one week later was also teported
as positive undiluted, with too weak a reaction to warrant
dilution. Shortly after this, on January 14. 1956, she
attended the out-patient department complaining of a sudden
severe painless bleeding following 12 weeks' amenorrhoea.
She admitted the possibility of further pregnancy, and was
taken into hospital for observation. As the blee'ding
continued it was decided to empty the uterus.
Two days after admission this was done under general
anaesthesia. when, on dilating the cervix, typical vesicles of
hydatidiform mole escaped. The uterus was emptied and a
curettage performed. Histological report of the curettings
was: " Hydatidiform mole. The trophoblast is fairly
active-looking, but no malignancy is seen." A Hogben test
12 days after evacuating the uterus was positive: eight days
later it was negative. The test was repeated monthly for
the first three months after she went home, and then at
gradually increasing intervals, and has remained negative.
Her menstrual cycle was regular, and repeated clinical
examinations have revealed no abnormality.
COMMENT
In this case the occurrence of a second hydatidiform
mole so soon after evacuation of the first raised the
problem of whether this was growth of mole remaining
from the first instance or a true second mole. The
negative curettage, negative Hogben test, and normal
menstrual cycle made the latter diagnosis tenable. In
half the cases reported in the literature, treatment of the
second mole was by evacuation of the uterus, in the
remainder by hysterectomy. In this case the patient is
anxious to have another child, and it was felt that
hysterectomy was not justifiable.
This case was first presented at a meeting of the Section
of Obstetrics and Gynaecology of the Royal Society of
Medicine held on January 25, 1957. My thanks are due to
Miss E. D. M. Wilson, under whose care this patient was
admitted, for permission to record this case and for her
encouragement and advice in the preparation of the paper.
DOROTHY M. GRATTON, M.B., Ch.B., M.R.C.O.G.,
Late Ohstetric and Gynaecological Registrar,
St. Helier Hospital, Carshalton, Surrey.
REFERENCES
Brews, A. (1939). J. Obstet. Gynaec. Brit. Emp., 46, 813.
Chesley, L. C.. Cosgrove, S. A., and Preece, J. (1946). Amer. J.
Obstet. Gynec., 52. 311.
Jaikaran, E. S. (1955). Brit. med. J., 2, 26.
Jeffreys, A. M, and Graffagnino, P. (1944). West. J. Surg., 52,
29.
Mathieu, A. (1937). Surg. Gvnec. Obstet., 64, 1021.
Moore, G. L., Secor, H. E., Kaufman, R. H., and Newton, B. L.
(1957) Ohrtet. and Gynec.. 10, 378.
Novak, E (1952). Gynecologic and Obstetric Pathology, 3rd ed.,
p. 503. Saunders, Philadelphia.
Posner, A. C., Kushner, J. I., and Posner, L. B. (1955). Obstet.
and Gynec., 5, 761.
Wall, R. L., and Hertig, A. T. (1948). Amer. J. Obstet. Gynec.,
56, 1127.