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A NEW POCKET CO2 SNOW OUTFIT
529 Chronic exhausting diseases, such as phthisis, were stated to have some connexion with the condition. Dr. J. F. CUNNINGHAM considered that Dr. Solomons had been fortunate in being able to make the diagnosis fairly early, as Csesarean section became In an ordinary case, he thought, the necessary. would be difficult until an attempt was diagnosis
made to remove the placenta. Dr. A. H. DAVIDSON said he had seen one case. He wondered if the condition were connected with some failure of the corpus luteum. Occasionally, in cases where manual removal of the placenta was needed, it proved possible to get a portion separated, while other portions would not come away. The chief difficulty was to know when to stop trying to take out the placenta. Radical treatment appeared to be the only treatment for the condition. Dr. NINIAN FALEiNER said he regarded placenta accreta in somewhat the same light as an ectopic pregnancy, because it undoubtedly was ectopic. The end-result of placenta accreta was that the chorionic elements were intertwined with the muscles of the uterine wall. This was the condition met with in ectopic pregnancy. He thought that in Dr. Solomon’s case there must have been pre-existing inflammation.
Dr. SOLOMONS, in reply, said that the placenta was in the upper segment. When he said that the diagnosis should be made as soon as possible, he meant that in a case of pelvic delivery efforts to remove the placenta should not be persisted in, and radical treatment should be undertaken, as soon as the diagnosis of placenta accreta was made. Among explanations of the condition failure of the corpus luteum might always be thought of, but it was more probably due to an inflammatory condition of the endometrium by which chorionic elements could get between the
glands
to the muscle.
many of which contained mitotic
figures, and there comparatively scanty syncytial masses. These structures occupied about four low-power fields of the microscope and were indistinguishable from chorion-epithelioma malignum. In discussing the case, Prof. O’Farrell asked his hearers by what criteria they would judge whether the specimen was an early malignant tumour or a benign condition.
were
The PRESIDENT said that cases of tubal pregnancy frequently seen, and if chorionic villi were malignant, then all these cases would be malignantwhich was not so. But he thought the present specimen was a chorionic epithelioma.-Prof. J. T. WiGHAM said it was usual to find some cystic condition of the ovary in cases in which there was chorionic epithelioma. He thought that if the ovary was found to have a normal corpus luteum on the affected side, that it would be rather against the idea that the condition was becoming malignant. He thought that chorionic epithelioma was either very rapidly malignant or else that it could be readily removed, when it proved to be histologically malignant but clinically non-malignant.-Dr. R. M. CoRBET said he thought the luteinisation of the ovary was the effect of too much trophoblast. It was the deciduum which influenced the ovary, and not the ovary which influenced the deciduum.-Dr. BETHEL SOLOMONS thought it looked as if the condition were definitely locally malignant, and that the patient would not be troubled again. He had almost never, he said, seen malignancy after a simple hydatidiform mole. Other specimens were shown.
were
NEW INVENTIONS A NEW POCKET
Dr. O’DONEL BROWNE read a paper on the Use of Pituitary Extract in Labour, and Dr. CUNNINGHAM a paper on Late Ectopic Pregnancy. Chorion-epithelioma of Fallopian Tube At a meeting of the section of pathology on Feb. 10th, with Dr. J. MCGRATH, the president, in the chair, Prof. T. T. O’FARRELL showed a specimen and reported the following case :— A woman, aged 35, had been married 15 years and had two children, the last having been born 11 years previous
to the present illness. Menstruation had been of the 28-day and of five days’ duration, the amount being heavy. Last period, Oct. 14th. Present illness : uterine hfemorrhage began on Dec. 5th, 1932 ; was not heavy, and lasted 14 days. There was no pain at this time, but there was slight pain in the lower abdomen during the following seven days. Haemorrhage during this time became more marked, and before admission to hospital there was acute pain in the lower abdomen for 12 hours. On admission (Dec. 26th) the patient was in a condition of shock; pulse-rate 125, temp. 97’F. There was acute tenderness and rigidity over the lower half of the abdomen, especially in the left iliac fossa. On vaginal examination the uterus was found to be small, hard, and in good position. A vague cystic mass was felt behind and on both sides of the uterus. At operation the pelvic cavity was seen to be filled with blood clot with a little fresh blood. The fimbriated end of the right tube looked as if an ectopic pregnancy had ruptured through the end. The right tube was removed. A large pyosalpinx was observed on the left side. The abdomen was closed, leaving a drainage-tube in position. Subsequent history : the lungs were radiographed with a negative result. The patient refused further operation and, after an uneventful recovery, left hospital in three weeks, not returning subsequently.
CO2
SNOW OUTFIT
of carbon dioxide snow in general practice for the treatment of nsevi, warts, and other skin conditions has been greatly hampered by the inconvenience of obtaining the requisite supplies of CO2, even the most " portable " apparatus being cumbersome, involving the carriage and transportation of
THE
use
type
The lumen of the tube, Prof. O’Farrell said, contained chorionic villi of about the fourth week type, and at one point there was definite invasion of the musculature. At this spot typical villi were scanty, there
was
marked
proliferation
of
Langhans’s cells,
This deficiency has been remedied by small attachment in nickelled brass and ebonite for use in conjunction with Sparklets J-size COg "resuscitator." The whole forms an outfit for CO. snow that can with truth be described as of pocket size. The attachment is screwed into the holder, by which action the 6 in. long " bulb " of CO2 is pierced, so that the escaping gas forms the snow in the expansion chamber from which it is moulded and compressed by means of the ebonite spatula supplied. Each " bulb " of CO will provide a rod of solid snow about 1 in. long and § in. in diameter. The apparatus is held pointing vertically downwards, so that the CO2 may be emitted into the expansion chamber in its liquid form. The bulbs are inex-pensive, empties are returnable for refilling and-most important-can be sent by post. The whole apparatus measures about 10 in., and the accompanying illustration shows its essential simplicity. The attachment is made by Sparklets, Angel-road, Upper Edmonton, N.18.
heavy cylinders. a
S. SHONE, M.D., M.R.C.P.
made to remove the placenta. Dr. A. H. DAVIDSON said he had seen one case. He wondered if the condition were connected with some failure of the corpus luteum. Occasionally, in cases where manual removal of the placenta was needed, it proved possible to get a portion separated, while other portions would not come away. The chief difficulty was to know when to stop trying to take out the placenta. Radical treatment appeared to be the only treatment for the condition. Dr. NINIAN FALEiNER said he regarded placenta accreta in somewhat the same light as an ectopic pregnancy, because it undoubtedly was ectopic. The end-result of placenta accreta was that the chorionic elements were intertwined with the muscles of the uterine wall. This was the condition met with in ectopic pregnancy. He thought that in Dr. Solomon’s case there must have been pre-existing inflammation.
Dr. SOLOMONS, in reply, said that the placenta was in the upper segment. When he said that the diagnosis should be made as soon as possible, he meant that in a case of pelvic delivery efforts to remove the placenta should not be persisted in, and radical treatment should be undertaken, as soon as the diagnosis of placenta accreta was made. Among explanations of the condition failure of the corpus luteum might always be thought of, but it was more probably due to an inflammatory condition of the endometrium by which chorionic elements could get between the
glands
to the muscle.
many of which contained mitotic
figures, and there comparatively scanty syncytial masses. These structures occupied about four low-power fields of the microscope and were indistinguishable from chorion-epithelioma malignum. In discussing the case, Prof. O’Farrell asked his hearers by what criteria they would judge whether the specimen was an early malignant tumour or a benign condition.
were
The PRESIDENT said that cases of tubal pregnancy frequently seen, and if chorionic villi were malignant, then all these cases would be malignantwhich was not so. But he thought the present specimen was a chorionic epithelioma.-Prof. J. T. WiGHAM said it was usual to find some cystic condition of the ovary in cases in which there was chorionic epithelioma. He thought that if the ovary was found to have a normal corpus luteum on the affected side, that it would be rather against the idea that the condition was becoming malignant. He thought that chorionic epithelioma was either very rapidly malignant or else that it could be readily removed, when it proved to be histologically malignant but clinically non-malignant.-Dr. R. M. CoRBET said he thought the luteinisation of the ovary was the effect of too much trophoblast. It was the deciduum which influenced the ovary, and not the ovary which influenced the deciduum.-Dr. BETHEL SOLOMONS thought it looked as if the condition were definitely locally malignant, and that the patient would not be troubled again. He had almost never, he said, seen malignancy after a simple hydatidiform mole. Other specimens were shown.
were
NEW INVENTIONS A NEW POCKET
Dr. O’DONEL BROWNE read a paper on the Use of Pituitary Extract in Labour, and Dr. CUNNINGHAM a paper on Late Ectopic Pregnancy. Chorion-epithelioma of Fallopian Tube At a meeting of the section of pathology on Feb. 10th, with Dr. J. MCGRATH, the president, in the chair, Prof. T. T. O’FARRELL showed a specimen and reported the following case :— A woman, aged 35, had been married 15 years and had two children, the last having been born 11 years previous
to the present illness. Menstruation had been of the 28-day and of five days’ duration, the amount being heavy. Last period, Oct. 14th. Present illness : uterine hfemorrhage began on Dec. 5th, 1932 ; was not heavy, and lasted 14 days. There was no pain at this time, but there was slight pain in the lower abdomen during the following seven days. Haemorrhage during this time became more marked, and before admission to hospital there was acute pain in the lower abdomen for 12 hours. On admission (Dec. 26th) the patient was in a condition of shock; pulse-rate 125, temp. 97’F. There was acute tenderness and rigidity over the lower half of the abdomen, especially in the left iliac fossa. On vaginal examination the uterus was found to be small, hard, and in good position. A vague cystic mass was felt behind and on both sides of the uterus. At operation the pelvic cavity was seen to be filled with blood clot with a little fresh blood. The fimbriated end of the right tube looked as if an ectopic pregnancy had ruptured through the end. The right tube was removed. A large pyosalpinx was observed on the left side. The abdomen was closed, leaving a drainage-tube in position. Subsequent history : the lungs were radiographed with a negative result. The patient refused further operation and, after an uneventful recovery, left hospital in three weeks, not returning subsequently.
CO2
SNOW OUTFIT
of carbon dioxide snow in general practice for the treatment of nsevi, warts, and other skin conditions has been greatly hampered by the inconvenience of obtaining the requisite supplies of CO2, even the most " portable " apparatus being cumbersome, involving the carriage and transportation of
THE
use
type
The lumen of the tube, Prof. O’Farrell said, contained chorionic villi of about the fourth week type, and at one point there was definite invasion of the musculature. At this spot typical villi were scanty, there
was
marked
proliferation
of
Langhans’s cells,
This deficiency has been remedied by small attachment in nickelled brass and ebonite for use in conjunction with Sparklets J-size COg "resuscitator." The whole forms an outfit for CO. snow that can with truth be described as of pocket size. The attachment is screwed into the holder, by which action the 6 in. long " bulb " of CO2 is pierced, so that the escaping gas forms the snow in the expansion chamber from which it is moulded and compressed by means of the ebonite spatula supplied. Each " bulb " of CO will provide a rod of solid snow about 1 in. long and § in. in diameter. The apparatus is held pointing vertically downwards, so that the CO2 may be emitted into the expansion chamber in its liquid form. The bulbs are inex-pensive, empties are returnable for refilling and-most important-can be sent by post. The whole apparatus measures about 10 in., and the accompanying illustration shows its essential simplicity. The attachment is made by Sparklets, Angel-road, Upper Edmonton, N.18.
heavy cylinders. a
S. SHONE, M.D., M.R.C.P.