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Millet, J., and Shell, J.: Meigs' Syndrome in a Case of Multilocular Pseudomucinous Cystadenoma of the Ovary
Selected Abstracts Gynecology Di Guglielmo, Lorenzo, and Pep.e, Antonio L.: Tuberculosis of the Endometrium, An. r1. Inst. matern. y asist. social, Buenos Aires 5: 168, 1943. The authors report a ease in which the diagnosis was made by histologic examination of the material obtained through exploratory curettement. The patient, aged 22 years, had dysmenorrhea beginning with the first menstruation at the age of 13 years. She married at 15 years of age, had never conceived, and had had amenorrhea since the age of 17 years, for whie.h she was treated with estrogens to no avail. She had genital hypoplasia and 40 per cent lymphocytes in the blood. This ease is instructive in that it indicates that in adolescent females with dysmenonhea or amenorrhea present since puberty, before making the diagnosis of an endocrine disorder and prescribing hormonal therapy, as was done in this ease, a specific infection should be ruled out, a point that many specialists are apt to forget. J. P. GREENHILL. DeCarie, Donald W.: So-Called Endometrioma Interstitiale, With the Report of Three Possible Case·s, West . .r. Surg. 53: 48, 1945. Interstitial endometrioma is a disease in which the interstitial cells of she endometrium take on the property of invasive growth. Under hormonal stimulation (estrin) these interstitial cells may invade the myometrium. In the chronic type the cells may stimulate fibrous tissue structure. If localized growth occurs, it may resemble a cellular iibroid. Until Goodall's original description of these tumors, they were all classified as sarcoma of the uterus. Two types of growth can occur: a generalized increasing of uterine mass, which on the cut section is pinkish-gray in color; or there may be local tumor formation, which on cut section appears as small yellow patches through the myometrium. The author reports three cases. In all of them, there was enlargement of the uterus, and, at the time of the operation, all were suspected of having Rarcoma. Microscopic section from the myometrium of these uteri showed numerous strands and islands of tissue resembling endometrial stroma. Occasional mitotic figures were seen. Overgrowth of muscle and fibrous tissue is associated with this pathologic state. This condition is a benign one, secondary to overstimulation by estrin. It is important that these cases be differentiated pathologically from sarcoma of the uterus. "\VILLIAM BICKERS.
Millet, J'., and Shell, J.: Meigs' Syndrome in a Case of Multilocular Pseudomucinous Cystadenoma of the Ovary, Am. J. M. Sc. 209: 327, 19-±5. In this careful case Teport the authors call attention to the importance of recognizing Meigs' syndrome, which, when correctly diagnosed and properly treated, results in 100 per cent cure. The undiagnosed cases may end fatally. The case reported is the second on record involving the combination of pseudomucinous cystadenoma accompanied by ascites and hydrothorax. It occurred in a 39-year-old woman whose complaints were referred primarily to the chest. After x-ray examination the chest fluid was removed by repeated thoracentesis, and at operation a large ovarian 523
524
AlVIERICAN JOURNAL O.B' OBSTE'I'RICS AND GYNECOLOGY
cyst extirpated. Postoperative removal of more fluid from the thorax was necessary but the patient made an otherwise uneventful recovery, and remained entirely well. The literature is reviewed and differential diagnosis discussed. A registry for the tabulation of cases of :Meigs' syndrome is suggested inespective of the type of ovarian tumor found so that a true basis for its incidence may be established.
Pregnancy, Complications, Etc. Finn, William F., and Lord, Jere W.: Carcinoma of the Colon Producing Acute Intestinal Obstruction During Pregnancy, Surg., Gynec. & Obst. 80: 545, 1945. The case history of a patient, six months pregnant, with carcinoma of the sigmoid and acute intestinal obstruction is reported. A transverse colostomy with decompression was first performed, and two weeks later the tumor was removed, the continuity of the bowel being restored by end-to-end anastomosis. Two weeks after this, the colostomy was closed. The patient was delivered normally at term of a normal infant. The case is reported because of the rarity of this complication of pregnancy with survival of the mother. The good result was, in the opinion of the authors, due to the fact that the carcinoma WaE operable and that it first manifested itself by the presence of obstruction rather than dystocia or peri toni tis. :M.C., USNR. Schwarcz, Ricardo, and Pinto, Roberto M.: ginec. de Buenos Aires 23: 337, 1944.
Prolonged Pregnancy, Bol. Soc. de obst. y
Accepting Wahl's concept that pregnancies which exceed :382.5 days counted from the first day of the last menstruation are prolonged, the authors have observed thirty-eight of these cases in the past few years. 'l'he pregnancies ranged from 290 to 315 days; eighteen were under 300 days, and fifteen beyond this limit, and 80 per cent of the women were primiparas. From a practical point of view, prolonged pregnancy nearly always occurs with an overdeveloped fetus which may result in serious mechanical dystocias causing fetomaternal morbidity and mortality, or intrauterine death of the fetus probably due to placental The interventions performed in the reported cases included six applications of for· ceps, six cesarean sections, one suture of the cervix and the lower uterine segment, and fifteen episiotomies. All the forceps applications were indicated by dystocia due to excessive fetal size; the weights of the fetuses ranged from 3,520 to 4,500 grams. No fetal or maternal mortality resulted from any of the interventions. However, there were four intrauterine fetal deaths, two of which occurred during the last days of pregnancy and two at the beginning of labor which was medically induced in one case. The duration of the four pregnancies was 290, 305, 310, and 315 days, respectively. Of the four dead fetuses, three were males; the preponderance of this sex in prolonged pregnancy has been observed by other authors. The excessive size of the fetus and its possible intrauterine death are the two fundamental factors on which are based the rules which obtain for the treatment of prolonged pregnancy. When the pregnancy reaches 280 days, careful observation of the woman is started, and this period is extended for twelve days. Between 292 and 302 days is the period of alarm when the various methods of interruption of pregnancy are considered; two methods are preferable: medical induction and cesarean section. Primary cesarean section is indicated in cases of fetal suffering, excessive fetal size (pelvicofetal disproportion) and previous fetal death in prolonged pregnancy. J. P. GREENHILL.
Millet, J'., and Shell, J.: Meigs' Syndrome in a Case of Multilocular Pseudomucinous Cystadenoma of the Ovary, Am. J. M. Sc. 209: 327, 19-±5. In this careful case Teport the authors call attention to the importance of recognizing Meigs' syndrome, which, when correctly diagnosed and properly treated, results in 100 per cent cure. The undiagnosed cases may end fatally. The case reported is the second on record involving the combination of pseudomucinous cystadenoma accompanied by ascites and hydrothorax. It occurred in a 39-year-old woman whose complaints were referred primarily to the chest. After x-ray examination the chest fluid was removed by repeated thoracentesis, and at operation a large ovarian 523
524
AlVIERICAN JOURNAL O.B' OBSTE'I'RICS AND GYNECOLOGY
cyst extirpated. Postoperative removal of more fluid from the thorax was necessary but the patient made an otherwise uneventful recovery, and remained entirely well. The literature is reviewed and differential diagnosis discussed. A registry for the tabulation of cases of :Meigs' syndrome is suggested inespective of the type of ovarian tumor found so that a true basis for its incidence may be established.
Pregnancy, Complications, Etc. Finn, William F., and Lord, Jere W.: Carcinoma of the Colon Producing Acute Intestinal Obstruction During Pregnancy, Surg., Gynec. & Obst. 80: 545, 1945. The case history of a patient, six months pregnant, with carcinoma of the sigmoid and acute intestinal obstruction is reported. A transverse colostomy with decompression was first performed, and two weeks later the tumor was removed, the continuity of the bowel being restored by end-to-end anastomosis. Two weeks after this, the colostomy was closed. The patient was delivered normally at term of a normal infant. The case is reported because of the rarity of this complication of pregnancy with survival of the mother. The good result was, in the opinion of the authors, due to the fact that the carcinoma WaE operable and that it first manifested itself by the presence of obstruction rather than dystocia or peri toni tis. :M.C., USNR. Schwarcz, Ricardo, and Pinto, Roberto M.: ginec. de Buenos Aires 23: 337, 1944.
Prolonged Pregnancy, Bol. Soc. de obst. y
Accepting Wahl's concept that pregnancies which exceed :382.5 days counted from the first day of the last menstruation are prolonged, the authors have observed thirty-eight of these cases in the past few years. 'l'he pregnancies ranged from 290 to 315 days; eighteen were under 300 days, and fifteen beyond this limit, and 80 per cent of the women were primiparas. From a practical point of view, prolonged pregnancy nearly always occurs with an overdeveloped fetus which may result in serious mechanical dystocias causing fetomaternal morbidity and mortality, or intrauterine death of the fetus probably due to placental The interventions performed in the reported cases included six applications of for· ceps, six cesarean sections, one suture of the cervix and the lower uterine segment, and fifteen episiotomies. All the forceps applications were indicated by dystocia due to excessive fetal size; the weights of the fetuses ranged from 3,520 to 4,500 grams. No fetal or maternal mortality resulted from any of the interventions. However, there were four intrauterine fetal deaths, two of which occurred during the last days of pregnancy and two at the beginning of labor which was medically induced in one case. The duration of the four pregnancies was 290, 305, 310, and 315 days, respectively. Of the four dead fetuses, three were males; the preponderance of this sex in prolonged pregnancy has been observed by other authors. The excessive size of the fetus and its possible intrauterine death are the two fundamental factors on which are based the rules which obtain for the treatment of prolonged pregnancy. When the pregnancy reaches 280 days, careful observation of the woman is started, and this period is extended for twelve days. Between 292 and 302 days is the period of alarm when the various methods of interruption of pregnancy are considered; two methods are preferable: medical induction and cesarean section. Primary cesarean section is indicated in cases of fetal suffering, excessive fetal size (pelvicofetal disproportion) and previous fetal death in prolonged pregnancy. J. P. GREENHILL.