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Early squamous-cell carcinoma of the cervix
REVIEWS
AND
335
ABSTRACTS
borne children or who have been subjected to some form of cervical traumatism with incid~ental infection. Chronic endocervicitis is, therefore, definitely a precursor of cervical cancer, and as such should be subjected to surgical treatment, which alone is curative. Low amputation and trachelorrhaphy are not curative. High amputation is frequently followed by serious functional disturbances. The Sturmdorf tracheloplastic operation, on the other hand, removes the entire disThe author has eased area, yet leaves the cervical musculature intact. used this operation for eight years in a large number of cases with enHe regards it as an efficient prophylactic of cervical tire satisfaction. cancer and believes that there is no contraindication to its use during the childbearing age. MARGARET SCHULZE.
Cullen:
EarZy Squamous-Cell
Gynecology
and Obstetrics,
Carcinoma 1921, xxxiii,
of the Cervix.
Surgery,
137.
This case represents the earliest carcinoma which has come to the attention of Cullen. An unmarried woman of 46 presented herself on account of uterine bleeding. Curettage showed a glandular hyperThe curetplasia of the endometrium with a small area of carcino’ma. tage was repeated in order to make the diagnosis positive, the second specimen showing typical carcinoma. A complete hysterectomy was done. The uterus contained a submucous fibroid whiclh, together with the hyperplasia, accounted for the bleeding. At the internal OS was found a small, wartlike projection, this being the only remaining evidence of the carcinoma. R. E. WOEUS.
Schweitzer: Att8empts to Decrease the Mortality of Operation Uterine Carcinoma8. Archiv fiir Gynakologie, 1921, cxiv, 213.
for
The Rumpf-Riess-Wertheim operation for carcinoma of the uterus has increased the proportion of curable cases; but the primary mortality from peritonitis, extraperitoneal sepsis, and pyelonephritis has remained high. It is not possible entirely to abolish peritonitis, because in some cases the infection is in the parametria or the lymphatits; but infection of the peritoneum by the unsterilizable vaginal surface of the carcinoma has been obviated by Zweifel, who after wide extirpation of the diseased pelvic organs, frees the uterus from all but its cuff of vagina. Three sutures are put into the posterior border of the bladder wall, left long, and the free ends put into the uterine wall. The uterus is then pushed down into the pelvis and the peritoneum closed over it. The abdomen is closed. The uterus is easily removed by cutting around the vaginal cuff, and the latter is attached to the bladder with the sutures that were pulled down with the uterus. The wound space above the vagina is filled for 10 days by loosely packed iodoform gauze. The bladder thus has an attachment for efficient contraction and the patient can void, while it is also protected from extension of infection from the vaginal wound. Within 10 years the Leipzig clinic has employed this method in 322 cases of carcinoma of the uterus, of which 41 involved the body and There were 16 deaths, a primary mort,ality of 4.96 per 281 the cervix. cent, peritonitis claiming 0.93 per cent. Among the 281 cases of carcinoma of the cervix, there were 15 primary deaths (5.8 per cent), peritonitis claiming 1.06 per cent and
AND
335
ABSTRACTS
borne children or who have been subjected to some form of cervical traumatism with incid~ental infection. Chronic endocervicitis is, therefore, definitely a precursor of cervical cancer, and as such should be subjected to surgical treatment, which alone is curative. Low amputation and trachelorrhaphy are not curative. High amputation is frequently followed by serious functional disturbances. The Sturmdorf tracheloplastic operation, on the other hand, removes the entire disThe author has eased area, yet leaves the cervical musculature intact. used this operation for eight years in a large number of cases with enHe regards it as an efficient prophylactic of cervical tire satisfaction. cancer and believes that there is no contraindication to its use during the childbearing age. MARGARET SCHULZE.
Cullen:
EarZy Squamous-Cell
Gynecology
and Obstetrics,
Carcinoma 1921, xxxiii,
of the Cervix.
Surgery,
137.
This case represents the earliest carcinoma which has come to the attention of Cullen. An unmarried woman of 46 presented herself on account of uterine bleeding. Curettage showed a glandular hyperThe curetplasia of the endometrium with a small area of carcino’ma. tage was repeated in order to make the diagnosis positive, the second specimen showing typical carcinoma. A complete hysterectomy was done. The uterus contained a submucous fibroid whiclh, together with the hyperplasia, accounted for the bleeding. At the internal OS was found a small, wartlike projection, this being the only remaining evidence of the carcinoma. R. E. WOEUS.
Schweitzer: Att8empts to Decrease the Mortality of Operation Uterine Carcinoma8. Archiv fiir Gynakologie, 1921, cxiv, 213.
for
The Rumpf-Riess-Wertheim operation for carcinoma of the uterus has increased the proportion of curable cases; but the primary mortality from peritonitis, extraperitoneal sepsis, and pyelonephritis has remained high. It is not possible entirely to abolish peritonitis, because in some cases the infection is in the parametria or the lymphatits; but infection of the peritoneum by the unsterilizable vaginal surface of the carcinoma has been obviated by Zweifel, who after wide extirpation of the diseased pelvic organs, frees the uterus from all but its cuff of vagina. Three sutures are put into the posterior border of the bladder wall, left long, and the free ends put into the uterine wall. The uterus is then pushed down into the pelvis and the peritoneum closed over it. The abdomen is closed. The uterus is easily removed by cutting around the vaginal cuff, and the latter is attached to the bladder with the sutures that were pulled down with the uterus. The wound space above the vagina is filled for 10 days by loosely packed iodoform gauze. The bladder thus has an attachment for efficient contraction and the patient can void, while it is also protected from extension of infection from the vaginal wound. Within 10 years the Leipzig clinic has employed this method in 322 cases of carcinoma of the uterus, of which 41 involved the body and There were 16 deaths, a primary mort,ality of 4.96 per 281 the cervix. cent, peritonitis claiming 0.93 per cent. Among the 281 cases of carcinoma of the cervix, there were 15 primary deaths (5.8 per cent), peritonitis claiming 1.06 per cent and