- Email: [email protected]
Familial multiple enchondroses complicating pregnancy
XEW
YORK
ACADEMY
OF
MEDICINE
s9
In regard to golf, tennis, etc., I did not meau that a woman should take uuusually violent exercise, simply that she might do the things she was accustomed to The average momar gets down and scrubs and does all kinds of housework. doing. Why not play golf or tennis? It is impossible to prexent women from doing many of these things except by constant supervision, and I have seen no ill results from freedom.. The teeth may bear some relation to the infection of the kidneys. The primary condition, howex-er, is the hydronephrosis, often due to constriction of the ureter by torsion just outside its junction with the bladder. I have tried both median and lateral episiotomy. The majority of primiparas ha.ve had median episiotomy, particularly if foreeps was applied. We hear the older obstetrieians say they never had a perineal tear. The pelves of women today are different. They are narrower and there is a closer approximation of the tuberosities of the ischium and a shorter bi-ischial diameter. Therefore a smaller proportion of children ean have a spontaneous birth, Very often you cannot save the muscles of the perineum unless it is cut, and cutting the perineum relieves pressure on the bladder and diminishes the possibility of cystoeele. I believe that, if you do an episiotomy and repair it: the woman i s better off in a. future pregnancy than if the perineum has been much distended or irregularly lacerated. I have seen patients go through a second labor after episiotomy without any damage of the perineum. Cnless there is considerable bleeding, I think it is better to leave the uterus alone, but I do not wait two hours. The less anesthesia, the better the uterus eontracts, and spontaneous contraction is better than that obtained by drugs. Dr. Btuddiford says that some of my patients were uncomfortable without cathnrties. Many, I believe, thought they were not getting enough attention. On the whole it has been pretty satisfactory, and a look at the charts will shorn that there were fewer rises in temperature in the patients who did not have cathartics. Dr. Dorman spoke of a cathartic being given when the milk was coming in. It used to be thought that the giving of castor oil prevent,ed milk fever. No one today believes in milk fever, and, if the woman is not going to nurse her baby, the milk will go just as quickly if you do not give a cathartic.
NEW SECTION
YORK
SIDNEY
droses
OF 111EDICIXE
ON OBSTETIRICS ASD GYNECOLOGY. STATED ING, HELD FEBRUARY 25, 1921. DR.
DR.
ACADElJIY
D. JACOBSON Cornplica~ting
HAROLD
BAILEY
presented
IN
a case
THE
JIEET-
CHAIR
of Familial
Multiple
Enchon-
Pregnancy.
The patient, Italian, twenty-three years of age, pregnant for the first time. At the age of eight she developed a, small chondromn of the wrist. The growth was Two or three years ago she was removed. At that time she had no other tumors. operated upon by Dr. Fowler of Brooklyn, who removed a portion of the right ilium. It was examiaed microscopically The tumor recurred and a year later was removed. While pathologically these tumors and found to contain pure cartilaginous tissue. About one year ago I removed a growth are benign, clinically they are malignant. from her abdominal wall. Within four months of the operation the woman became deposit higher up in the pregnant and it was found that she had a metastatie The older one of these tumors a,bdomen and one of more rec.ent growth lower down. In this ‘case the tumors shows a softened center indicating mucoid degeneration.
90
THE
AMERICAN
JOCRXAL
OF
OBSTETRICS
AND
GYNECOLOGY
are of the familial
type. ‘The woman’s father, who maa also presented, has a eharaeteristic bowing of the radius and ulna and a deposit on one rib. A paternal uncle had the same condition. The removal of these tumors does practically no good because they continue to recur and eventually one forms near a vital organ,
causing death. The patient has been advised to have her pregnancy terminated. It is a question whether it. is wiser to terminate the pregnancy or to remove the tumor. The tumors are large and their removal will mean the resection of a large portion of the abdominal wall, and with the uterus increasing in size there would be danger of a large ventral hernia. Another point that has influenced me in deciding to let the pregnancy a,lone is the fact that during pregnacy there is a deposit of calcium salts in the maternal body which nature removes later and I have hope that she might be cured in this way since our therapy has been unable to do so. The x-ray photographs shown demonstrate that the patient has these tumors in her legs, arms and in practically every bone of her body. Cases are on record in which an enchondroma has been known to perforate the bladder or pregnant uterus. Numerous eases have been reported in which paralysis has resulted from pressure of these tumors on a nerve, and cases of aneurysm are reported as a result of their impingement on blood vessels, their sharp point having lacerated the fibrous coat of the vessel. DISCUSSION DR. I3. C. BAILEY.-This case presents some interesting features. There is the question whether she should be allowed to go on with her pregnancy. There is no doubt that in this tumor there are malignant tendencies. We know that during or immedia.tely after pregnancy there is a rapid growth of all tumors. A point that is both interesting and odd is that at the Memorial Hospital we have never had a case of general enchondrosis. Tumors of this type should be nonmalignant. Why does this one show a tendency to metastasize? DR. FREDERICK W. RICE.-1 have examined Dr. Jacobson’s x-ray shows the pelvis free from the growth, I do not see why the labor should be affected in any way by the new growth. DR. CHARLES B. DAVENPORT.-I am interested family history and have made inquiries of the father osteoses. He states that his father, his father’s mother, condition.
M. HELLNAN
the and
in this ease because of the who himself shows the same and a brother had the same
DR. CHARLES CHILDS.-Before giving an opinion as to terminating pregnancy I should like to know more of the patient’s These tumors are not to my mind an indication for the interruption
DR. ALFRED
ease. If pregnancy
the desirability of general condition. of pregnancy.
reported a case and ~presented.a specimen of
Chorioepithelioma. Xrs. U., aged fifty, presented herself at my office, November 27, 1920. She had been married twenty-three years, had seven children, and several miscarriages. The youngest child was full grown. The last misearriage was in February, 1920, nine months before I saw her. She quotes her physieian as saying that at that time she was four months pregnant. She had had no complete cessation r\f menses. After curettage at that time she bled irregularly for from four to six weeks and then stopped for two reeks. Two weeks before coming under my observation she was again curetted for severe hemorrhage. This failed to stop the bleeding.
YORK
ACADEMY
OF
MEDICINE
s9
In regard to golf, tennis, etc., I did not meau that a woman should take uuusually violent exercise, simply that she might do the things she was accustomed to The average momar gets down and scrubs and does all kinds of housework. doing. Why not play golf or tennis? It is impossible to prexent women from doing many of these things except by constant supervision, and I have seen no ill results from freedom.. The teeth may bear some relation to the infection of the kidneys. The primary condition, howex-er, is the hydronephrosis, often due to constriction of the ureter by torsion just outside its junction with the bladder. I have tried both median and lateral episiotomy. The majority of primiparas ha.ve had median episiotomy, particularly if foreeps was applied. We hear the older obstetrieians say they never had a perineal tear. The pelves of women today are different. They are narrower and there is a closer approximation of the tuberosities of the ischium and a shorter bi-ischial diameter. Therefore a smaller proportion of children ean have a spontaneous birth, Very often you cannot save the muscles of the perineum unless it is cut, and cutting the perineum relieves pressure on the bladder and diminishes the possibility of cystoeele. I believe that, if you do an episiotomy and repair it: the woman i s better off in a. future pregnancy than if the perineum has been much distended or irregularly lacerated. I have seen patients go through a second labor after episiotomy without any damage of the perineum. Cnless there is considerable bleeding, I think it is better to leave the uterus alone, but I do not wait two hours. The less anesthesia, the better the uterus eontracts, and spontaneous contraction is better than that obtained by drugs. Dr. Btuddiford says that some of my patients were uncomfortable without cathnrties. Many, I believe, thought they were not getting enough attention. On the whole it has been pretty satisfactory, and a look at the charts will shorn that there were fewer rises in temperature in the patients who did not have cathartics. Dr. Dorman spoke of a cathartic being given when the milk was coming in. It used to be thought that the giving of castor oil prevent,ed milk fever. No one today believes in milk fever, and, if the woman is not going to nurse her baby, the milk will go just as quickly if you do not give a cathartic.
NEW SECTION
YORK
SIDNEY
droses
OF 111EDICIXE
ON OBSTETIRICS ASD GYNECOLOGY. STATED ING, HELD FEBRUARY 25, 1921. DR.
DR.
ACADElJIY
D. JACOBSON Cornplica~ting
HAROLD
BAILEY
presented
IN
a case
THE
JIEET-
CHAIR
of Familial
Multiple
Enchon-
Pregnancy.
The patient, Italian, twenty-three years of age, pregnant for the first time. At the age of eight she developed a, small chondromn of the wrist. The growth was Two or three years ago she was removed. At that time she had no other tumors. operated upon by Dr. Fowler of Brooklyn, who removed a portion of the right ilium. It was examiaed microscopically The tumor recurred and a year later was removed. While pathologically these tumors and found to contain pure cartilaginous tissue. About one year ago I removed a growth are benign, clinically they are malignant. from her abdominal wall. Within four months of the operation the woman became deposit higher up in the pregnant and it was found that she had a metastatie The older one of these tumors a,bdomen and one of more rec.ent growth lower down. In this ‘case the tumors shows a softened center indicating mucoid degeneration.
90
THE
AMERICAN
JOCRXAL
OF
OBSTETRICS
AND
GYNECOLOGY
are of the familial
type. ‘The woman’s father, who maa also presented, has a eharaeteristic bowing of the radius and ulna and a deposit on one rib. A paternal uncle had the same condition. The removal of these tumors does practically no good because they continue to recur and eventually one forms near a vital organ,
causing death. The patient has been advised to have her pregnancy terminated. It is a question whether it. is wiser to terminate the pregnancy or to remove the tumor. The tumors are large and their removal will mean the resection of a large portion of the abdominal wall, and with the uterus increasing in size there would be danger of a large ventral hernia. Another point that has influenced me in deciding to let the pregnancy a,lone is the fact that during pregnacy there is a deposit of calcium salts in the maternal body which nature removes later and I have hope that she might be cured in this way since our therapy has been unable to do so. The x-ray photographs shown demonstrate that the patient has these tumors in her legs, arms and in practically every bone of her body. Cases are on record in which an enchondroma has been known to perforate the bladder or pregnant uterus. Numerous eases have been reported in which paralysis has resulted from pressure of these tumors on a nerve, and cases of aneurysm are reported as a result of their impingement on blood vessels, their sharp point having lacerated the fibrous coat of the vessel. DISCUSSION DR. I3. C. BAILEY.-This case presents some interesting features. There is the question whether she should be allowed to go on with her pregnancy. There is no doubt that in this tumor there are malignant tendencies. We know that during or immedia.tely after pregnancy there is a rapid growth of all tumors. A point that is both interesting and odd is that at the Memorial Hospital we have never had a case of general enchondrosis. Tumors of this type should be nonmalignant. Why does this one show a tendency to metastasize? DR. FREDERICK W. RICE.-1 have examined Dr. Jacobson’s x-ray shows the pelvis free from the growth, I do not see why the labor should be affected in any way by the new growth. DR. CHARLES B. DAVENPORT.-I am interested family history and have made inquiries of the father osteoses. He states that his father, his father’s mother, condition.
M. HELLNAN
the and
in this ease because of the who himself shows the same and a brother had the same
DR. CHARLES CHILDS.-Before giving an opinion as to terminating pregnancy I should like to know more of the patient’s These tumors are not to my mind an indication for the interruption
DR. ALFRED
ease. If pregnancy
the desirability of general condition. of pregnancy.
reported a case and ~presented.a specimen of
Chorioepithelioma. Xrs. U., aged fifty, presented herself at my office, November 27, 1920. She had been married twenty-three years, had seven children, and several miscarriages. The youngest child was full grown. The last misearriage was in February, 1920, nine months before I saw her. She quotes her physieian as saying that at that time she was four months pregnant. She had had no complete cessation r\f menses. After curettage at that time she bled irregularly for from four to six weeks and then stopped for two reeks. Two weeks before coming under my observation she was again curetted for severe hemorrhage. This failed to stop the bleeding.