- Email: [email protected]
Bates, Robley, Jr., and Rucker, Pierce M.: Tuberculosis of the Vulva
290
AMERICA X JOURNAL OF OBSTETRICS AXD GYXECOLOGY
cordance with the extent of the lesion and the patient's age, total hysterectomy, or suhtotal, with the po~sibility of saving the adnexa.; (0'» roentgen therapy for viHecral metastases; (6) vltginal surgery antl radium for vaginal nH'1.a~tase" .
.T. P.
GREE~HlLL
D'Aquila, H. P.: Erythrosedimentation in Complicated Myomas, An. Catedra de clin. ginec. 2: 251-258, 1043. The author discusses this subjeet with ,1etai1s from nine illustrative cases. She believes that a high seuimentation rate in the presence of uterine fibromyoma (eliminating other causes for this finding) is a definite indication of a complicated lesion, even though gynecologic examination may not reveal any abnormality. Histopathologic study should always be carrieu out after operation for removal of a myoma accompanied by high sedimentation rate. This will reveal areas of tissue showing necrobiosis, hyaline and mu~ous degenerations, 10l'ulizeu infection, and sometimes sarcomatous and carcinomatous zones. Circulatory changes constitute approximately 30 per cent of the complications ill uterine myomas .
.T. P. Lavarello, A. G.: 272-288, ]943.
GREEXHTLI,
Central Abscess of the Ovary, An. Catedra de olin. ginec. 2:
Central abscess of the ovary and abscess of the corpu~ luteum are, from the anatomopathologic standpoint, two distinet proces~eH. The former, surrounded, that is, within the elements of the organ, causes profounu changes hoth in function and structure; there arc progre~sive stageF, from normal tissue to total destruction of the ovary, at wllOse expense the purulent cavity is formed. In an abscess of the corpus luieum, the process may be called peripheral, and there is not destruction, but alteration, usually of the infiltrative type, of the partB of the ovary adjoining the process. Most authors regard the pathogenesis of el'ntral abscc~s as of puerperal origin, either post partum or postabortive, and from his observations, the author is inclined to agree. In regard to classification, the author suggests that, on an anatomopathologic basis, central abscess should be included in chronic interstitial oophoritis, while luteal abscess belong~ to the acute types of ovarian inflammation due to peripheral infection.
J. P. Bates, Robley, Jr., and Rucker, Pierce M.: M. ~fonthly 71: 190, 1944.
GREEN lIlLI,
Tuberculosis of the Vulva, Virginia
'l'uberculosis of the vulva is the rarest form of genital tuberculosis. It must be differentiated from esthiomene, tertiary syphilis, granuloma inguinale, and carcinoma. The vulval lesion may be either primary or l'E'condal'y, the former beingrare and difficult to prove eonclusively. 'l'hat it may be lwquired by lo~ul inoculation at coitus is open to question, but it is true that the disease has been produced in the vagina of guinea pigs after first sensitizing the animals. In. the secondary cases, the infection often extends from a neighboring organ Buch as bladder or rectum, and of course, may result from a deseending infection from the vagina or uterus. Prognosis must be guarded, spontaneouB healing sometimes occurs. '1'he treatment is not well established, but cases are cited from the literature treated by excision, radiation, or local application of zinc chloride in alcohol. The authors report a case of secondary vulval tuberculosis with a history of pulmonary tuberculosis in 1935, a history of rectovaginal fistula in 1932. At the
ABSTRACTS
291
age of 44, she reported for examination, not for the ukcr on her vulva, but to see if Rhe was pregnant. A photograph of the lesion is ,.hown together with the photomicrograph of the tissue removed for biopsy. The base of the ulcer was granular and bathed with pus, it was acutely tender. The genitals were otherwise negative. The pathologist reported "nests of epithelioid cells situated just below the epithe· Iium and surrounding giant cells of the tuberculous type." Although acid-fast stains coulu not be uone, the histologic findings were characteristi{' of tuberculosis. X 0 treatment was instituted because of the patient's ('xtrcme pulmonary involvement. She died a few months after the local lesion was discovered. WU,TaAl{ BICKERS
Gynecologic Operations BOlTas; P. E.: Obstruction of the Bladder Neck in Women, An. Catedra de clin. ginec. 2: 130-156, 1943. 'I.'wo cases are reported by the author with discussion of symptoms, endoscopic signs, pathologic anatomy and treatment. Tho outstanding symptom is painful and difficult urination. Occasionally, there is some hematuria and urinary retention. Following the local symptoms, general disturbances result from lack of rest, dis· tracting pain, inability to work, and increasing nervO\l~ness, which is exaggerated with the failure of all medical treatment. The cystoscopic picture is characterized by thickness of the vesical columns and cells, and sometimes by true diverticuli, which reflect the pressure· to which the bladder musculature has been subjected because of the obstruction at the outlet due to rigidity of the sphincter. The muscular coat of the sphineter, histologically, shows, marked hypertrophy and hyperplasia of the fibers, changing their disposition into a picture resembling uterine myoma. 'iVithin the muscular tissue, infiltration of inflammatory elements may be found, and always a sclerotic process which leads toward fihrous tran~formation of these clements of the bladder neck. Once the diagnosis of disease of the bladder neck has been made, there is only one treatment and that is surgical. It is necessary to open the bladder neck itself, and three routes may be utilized, perineal, endourethral or vaginal, and transurethral. The sclerotic portion of the bladder neck is destroyed through a resectoscope, preferably, the MacCarthy instrument, because it allows viHion of the surgical field, and extensive areas of tissue can be resected rapidly, because of the variation in form and size of the eler-trodes. The two patients rep(\rted were operated by the transvesical route, because a MacCarthy resectoscope was not available at the time, and the transurethral route promised to be difficult because the bladder in both instances could stand little distention. Marion prefers the transv(Jsical route in all cases because it allows complete and radical operation without increasing the risks, and because it permits exaM calculation of the zone to be extirpated, and even allows complete removal of the bladder neck. The author, however, notwithstanding the good results in his two cases with this method, believes that, generally, the transurethral approach is the one of choice. .r. P. GREEKUIT,L BOlTas, P. E.: Morbidity and Mortality in Surgical Treatment of Uterine Tumors, An. Catedra do clin. ginec. 2: 90-96, 1943. The author presents a statistical study of ] ,240 caRes representing a 3D-year experience on two surgical services. In the majority of instances (968), the tumors were fibromyomas; in only 22 cases was cancer present with the fibromas. The predominant symptom was menorrhagia or metrorrhagia in 687 cases (54.83 percent). In 663 instances, another operation, such as appendectomy, salpingectomy, etc., was performed concomitantly.
AMERICA X JOURNAL OF OBSTETRICS AXD GYXECOLOGY
cordance with the extent of the lesion and the patient's age, total hysterectomy, or suhtotal, with the po~sibility of saving the adnexa.; (0'» roentgen therapy for viHecral metastases; (6) vltginal surgery antl radium for vaginal nH'1.a~tase" .
.T. P.
GREE~HlLL
D'Aquila, H. P.: Erythrosedimentation in Complicated Myomas, An. Catedra de clin. ginec. 2: 251-258, 1043. The author discusses this subjeet with ,1etai1s from nine illustrative cases. She believes that a high seuimentation rate in the presence of uterine fibromyoma (eliminating other causes for this finding) is a definite indication of a complicated lesion, even though gynecologic examination may not reveal any abnormality. Histopathologic study should always be carrieu out after operation for removal of a myoma accompanied by high sedimentation rate. This will reveal areas of tissue showing necrobiosis, hyaline and mu~ous degenerations, 10l'ulizeu infection, and sometimes sarcomatous and carcinomatous zones. Circulatory changes constitute approximately 30 per cent of the complications ill uterine myomas .
.T. P. Lavarello, A. G.: 272-288, ]943.
GREEXHTLI,
Central Abscess of the Ovary, An. Catedra de olin. ginec. 2:
Central abscess of the ovary and abscess of the corpu~ luteum are, from the anatomopathologic standpoint, two distinet proces~eH. The former, surrounded, that is, within the elements of the organ, causes profounu changes hoth in function and structure; there arc progre~sive stageF, from normal tissue to total destruction of the ovary, at wllOse expense the purulent cavity is formed. In an abscess of the corpus luieum, the process may be called peripheral, and there is not destruction, but alteration, usually of the infiltrative type, of the partB of the ovary adjoining the process. Most authors regard the pathogenesis of el'ntral abscc~s as of puerperal origin, either post partum or postabortive, and from his observations, the author is inclined to agree. In regard to classification, the author suggests that, on an anatomopathologic basis, central abscess should be included in chronic interstitial oophoritis, while luteal abscess belong~ to the acute types of ovarian inflammation due to peripheral infection.
J. P. Bates, Robley, Jr., and Rucker, Pierce M.: M. ~fonthly 71: 190, 1944.
GREEN lIlLI,
Tuberculosis of the Vulva, Virginia
'l'uberculosis of the vulva is the rarest form of genital tuberculosis. It must be differentiated from esthiomene, tertiary syphilis, granuloma inguinale, and carcinoma. The vulval lesion may be either primary or l'E'condal'y, the former beingrare and difficult to prove eonclusively. 'l'hat it may be lwquired by lo~ul inoculation at coitus is open to question, but it is true that the disease has been produced in the vagina of guinea pigs after first sensitizing the animals. In. the secondary cases, the infection often extends from a neighboring organ Buch as bladder or rectum, and of course, may result from a deseending infection from the vagina or uterus. Prognosis must be guarded, spontaneouB healing sometimes occurs. '1'he treatment is not well established, but cases are cited from the literature treated by excision, radiation, or local application of zinc chloride in alcohol. The authors report a case of secondary vulval tuberculosis with a history of pulmonary tuberculosis in 1935, a history of rectovaginal fistula in 1932. At the
ABSTRACTS
291
age of 44, she reported for examination, not for the ukcr on her vulva, but to see if Rhe was pregnant. A photograph of the lesion is ,.hown together with the photomicrograph of the tissue removed for biopsy. The base of the ulcer was granular and bathed with pus, it was acutely tender. The genitals were otherwise negative. The pathologist reported "nests of epithelioid cells situated just below the epithe· Iium and surrounding giant cells of the tuberculous type." Although acid-fast stains coulu not be uone, the histologic findings were characteristi{' of tuberculosis. X 0 treatment was instituted because of the patient's ('xtrcme pulmonary involvement. She died a few months after the local lesion was discovered. WU,TaAl{ BICKERS
Gynecologic Operations BOlTas; P. E.: Obstruction of the Bladder Neck in Women, An. Catedra de clin. ginec. 2: 130-156, 1943. 'I.'wo cases are reported by the author with discussion of symptoms, endoscopic signs, pathologic anatomy and treatment. Tho outstanding symptom is painful and difficult urination. Occasionally, there is some hematuria and urinary retention. Following the local symptoms, general disturbances result from lack of rest, dis· tracting pain, inability to work, and increasing nervO\l~ness, which is exaggerated with the failure of all medical treatment. The cystoscopic picture is characterized by thickness of the vesical columns and cells, and sometimes by true diverticuli, which reflect the pressure· to which the bladder musculature has been subjected because of the obstruction at the outlet due to rigidity of the sphincter. The muscular coat of the sphineter, histologically, shows, marked hypertrophy and hyperplasia of the fibers, changing their disposition into a picture resembling uterine myoma. 'iVithin the muscular tissue, infiltration of inflammatory elements may be found, and always a sclerotic process which leads toward fihrous tran~formation of these clements of the bladder neck. Once the diagnosis of disease of the bladder neck has been made, there is only one treatment and that is surgical. It is necessary to open the bladder neck itself, and three routes may be utilized, perineal, endourethral or vaginal, and transurethral. The sclerotic portion of the bladder neck is destroyed through a resectoscope, preferably, the MacCarthy instrument, because it allows viHion of the surgical field, and extensive areas of tissue can be resected rapidly, because of the variation in form and size of the eler-trodes. The two patients rep(\rted were operated by the transvesical route, because a MacCarthy resectoscope was not available at the time, and the transurethral route promised to be difficult because the bladder in both instances could stand little distention. Marion prefers the transv(Jsical route in all cases because it allows complete and radical operation without increasing the risks, and because it permits exaM calculation of the zone to be extirpated, and even allows complete removal of the bladder neck. The author, however, notwithstanding the good results in his two cases with this method, believes that, generally, the transurethral approach is the one of choice. .r. P. GREEKUIT,L BOlTas, P. E.: Morbidity and Mortality in Surgical Treatment of Uterine Tumors, An. Catedra do clin. ginec. 2: 90-96, 1943. The author presents a statistical study of ] ,240 caRes representing a 3D-year experience on two surgical services. In the majority of instances (968), the tumors were fibromyomas; in only 22 cases was cancer present with the fibromas. The predominant symptom was menorrhagia or metrorrhagia in 687 cases (54.83 percent). In 663 instances, another operation, such as appendectomy, salpingectomy, etc., was performed concomitantly.