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Tubal sterilization by the madlener method
177
ABSTRAC’I’S
patient is given a series of 12 to 25 short wave diathermy treatments to the deep Last, pelvic tissue. The heat therapy is administered upon alternate days. following the heat therapy courses, the patient is given an intramuscular injection of follicular hormone, 5 mg. every fifth day, for a total dosage of 25 to 30 mg. (250,000 to 300,000 mouse units). The author insists that the hormonal therapy must be given in the first half of the menstrual cycle. Clauberg states that corollary to uterine growth the tubes show a correspondingly distinctive growth stimulation. He demonstrates, with roentgenographic evidence, that nonpatent tubes prior to the above-mentioned treatment, do become patent. In those patients with infantile-like uteri and demonstrable nonpatency of the tubes, he was able to relieve sterility with only the hormonal treatment. A series of halftone plates illustrate the author’s evidence of convincing uterograms, taken before and after treatment. CLAIR E. FOLSOME.
Amundsen, Obst.
E. :
& Gynec.
Is Sterilization Scandinav.
20:
During 295,
the 1940.
Puerperium
Contraindicated?
Acta.
When sterilization must be performed, the best time for the operation is shortly following delivery. The advantages are that the patient is still in the hoepital and that from a technical point of view the operation is simple. In a series of 150 sterilizations performed shortly after delivery at the Oslo Clinic, there were no deaths. Most of the operations were performed on the third day after delivery. Local anesthesia was used in practically all the cases, and the operation employed was resection of the tubal corners. In none of the cases was there any sign of infection or embolism, although thrombosis appeared in six eases. When a series of patients operated upon before 1932 is added to the present series, it is found that the incidence of thrombosis following sterilization is about 2 per cent. The author believes that this incidence could be considerably reduced by performing the operation on the first day after deliver? In the discussion of this paper Sund mentioned that this method of sterilization was invented by Mannen thirteen years ago. Sund has performed about 300 such sterilizations and has not observed any deaths or any serious complications. 5. P. GREENHILL.
Dippel, A. Louis: Obst.
71:
Tubal
Sterilization
by the Madlener
Method,
Surg.,
Gynec.
&
94, 1940.
Five clinical failures of tubal sterilization by the Madlener method were encountered in a series of 101 patients. The areas of attempted sterilization were recovered at the time of a second sterilizing operation, from both tubes of 4 of these patients, and from 1 tube of the other. Each area was serially sectioned to ascertain the reason for failure. One patient had a very early pregnancy at the time of the Madlener sterilizaIn 2 instances considerable regeneration of the tubal lumen occurred, so tion. that the ligating suture must have been improperly tied or placed or slipped off the knuckle. This error was bilateral in 1 case. In a fourth patient the tubal lumina were apparently completely obliterated but eventually an inferior lumen was re-established on one side by endosalpingosis. In the fifth instance, both tubal lumina were replaced by scar tissue but a small tuboperitoneal fistula apparently developed as a result of endosalpingosis on the medial side of the ligated knuckle of one tube. The number of failures of tubal sterilization by this method should be reduced by more careful adherence to the technique as originally laid down by Madlener, although certain modifications do not seem to have increased the incidence of failures. There were no maternal deaths associated with the 101 Madlener sterilization operations but in 369 women sterilized by other methods during the same years, 7 deaths occurred. WILLIAM C. HENSKE.
ABSTRAC’I’S
patient is given a series of 12 to 25 short wave diathermy treatments to the deep Last, pelvic tissue. The heat therapy is administered upon alternate days. following the heat therapy courses, the patient is given an intramuscular injection of follicular hormone, 5 mg. every fifth day, for a total dosage of 25 to 30 mg. (250,000 to 300,000 mouse units). The author insists that the hormonal therapy must be given in the first half of the menstrual cycle. Clauberg states that corollary to uterine growth the tubes show a correspondingly distinctive growth stimulation. He demonstrates, with roentgenographic evidence, that nonpatent tubes prior to the above-mentioned treatment, do become patent. In those patients with infantile-like uteri and demonstrable nonpatency of the tubes, he was able to relieve sterility with only the hormonal treatment. A series of halftone plates illustrate the author’s evidence of convincing uterograms, taken before and after treatment. CLAIR E. FOLSOME.
Amundsen, Obst.
E. :
& Gynec.
Is Sterilization Scandinav.
20:
During 295,
the 1940.
Puerperium
Contraindicated?
Acta.
When sterilization must be performed, the best time for the operation is shortly following delivery. The advantages are that the patient is still in the hoepital and that from a technical point of view the operation is simple. In a series of 150 sterilizations performed shortly after delivery at the Oslo Clinic, there were no deaths. Most of the operations were performed on the third day after delivery. Local anesthesia was used in practically all the cases, and the operation employed was resection of the tubal corners. In none of the cases was there any sign of infection or embolism, although thrombosis appeared in six eases. When a series of patients operated upon before 1932 is added to the present series, it is found that the incidence of thrombosis following sterilization is about 2 per cent. The author believes that this incidence could be considerably reduced by performing the operation on the first day after deliver? In the discussion of this paper Sund mentioned that this method of sterilization was invented by Mannen thirteen years ago. Sund has performed about 300 such sterilizations and has not observed any deaths or any serious complications. 5. P. GREENHILL.
Dippel, A. Louis: Obst.
71:
Tubal
Sterilization
by the Madlener
Method,
Surg.,
Gynec.
&
94, 1940.
Five clinical failures of tubal sterilization by the Madlener method were encountered in a series of 101 patients. The areas of attempted sterilization were recovered at the time of a second sterilizing operation, from both tubes of 4 of these patients, and from 1 tube of the other. Each area was serially sectioned to ascertain the reason for failure. One patient had a very early pregnancy at the time of the Madlener sterilizaIn 2 instances considerable regeneration of the tubal lumen occurred, so tion. that the ligating suture must have been improperly tied or placed or slipped off the knuckle. This error was bilateral in 1 case. In a fourth patient the tubal lumina were apparently completely obliterated but eventually an inferior lumen was re-established on one side by endosalpingosis. In the fifth instance, both tubal lumina were replaced by scar tissue but a small tuboperitoneal fistula apparently developed as a result of endosalpingosis on the medial side of the ligated knuckle of one tube. The number of failures of tubal sterilization by this method should be reduced by more careful adherence to the technique as originally laid down by Madlener, although certain modifications do not seem to have increased the incidence of failures. There were no maternal deaths associated with the 101 Madlener sterilization operations but in 369 women sterilized by other methods during the same years, 7 deaths occurred. WILLIAM C. HENSKE.