- Email: [email protected]
Indications for total hysterectomy in nonmalignant conditions of the uterus
Brief Christian histologic expressions
descriptions of eosinophilic granuloma disease, and Letterer-Siwe disease are and clinical evidence indicates that all of the same basic disease process.
Therapy palliation.
is
inadequate
hut
roentgen
treatment
of skin and bone, Hand-Schiillergiven. The authors believe that the of these conditions are reall,v different or
local
excision ROBERT
Barns,
may
yield
good
B. WILSON
Tom, and Snaith, Linton M.: Tuberculous Cervicitis; A Report on Two Cases and a Note Upon the Natural History of the Condition, .T. Obst. & Gynaec. Brit. Emp. 60: Xl,
1953.
Two
cases of tuberculous cervicitis are described. The first occurred in a E-year-old patient who had a premature labor following an antepartum hemorrhage at 30 weeks’ gestation. Pulmonary tuberculosis was unrecognized in her antepartum course but subsequently serial x-rays were regarded as evidence that a very early tuberculous lesion of the lung developed during pregnancy. Six weeks post partum a persistent low-grade fever was observed and examination revealed a right-sided tubal mass. Diagnostic curettage and cervical biopsy revealed typical miliary tuberculosis in the endometrium and cervix and on bacteriological examination tubercle bacilli were recovered from the endometrium. The second patient was a 25-year-old woman who developed a pleural effusion at 24 years of age. During the time of the pleural effusion, the patient’s menses underwent striking alterations from a 28 day cycle lasting 6 days to a 35 day cycle lasting 11 days. Pelvic examination revealed a florid, proliferative mass growing from the cervix, which bled Dilatation and curettage and cervical biopsy readily and was hard, irregular, and painless. revealed tuberculous endometritis and cervicitis. The authors believe that female genital tuberculosis develops during the phase of bacteremia which is known to occur during and for a short time after the development of the primary tuberculous focus. They state that owing to the rarit,y with which the appear that genital tuberculosis is primary infection occurs after the age of 20, it would however long it may remain latent before discovery essentially a disease of adolescence, in later life. GEORGE HCH.~EFER
Gynecologic
Operations
deMorales, Arnaldo : Indications for Total Hysterectomy the Uterus, Arq. de clin. ginec. 4: 11, 1951.
in Nonmalignant
Conditions
of
After reviewing the literature of the last decade where the indications for total hysterectomy in nonmalignant conditions of the uterus are discussed, and the advantages of total over subtotal hysterectomy in these eases are emphasized, the author quotes the statistics reported by the different clinics on the incidence of cancer of the cervical stump and the results of vaginal and abdominal total hysterectomy. Reporting on his experiences in Brazil where he has, for a long time, advocated hysterectomy in the treatment of nonmalignant conditions of the uterus in women menopause or postmenopausal period, primarily for the prevention of cancer, he figures obtained in his gynecological clinic where a c.onservative policy for the group of women is followed, although total hysterectomy is usually indicated for ones. Twelve cases of cancer of the cervical stump, after subtotal hysterectomy, served in his clinic.
total at the cites the younger the older were ob-
It is obvious that no procedure in any clinic. may be considered as a constant routine. There are indications for vaginal hysterectomy as well as for abdominal hysterectomy. be the method of choice, since it excludes Total hysterectomy, in the latter cases, should the danger of an infected or cancerous cervix.
Volume 67 Number 1
Total The author ent trend continuing
SELECTEL,
217
AHSTRACTS
hysterectomy has advantages which advocate its use in the majority feels satisfied, therefore, that in the light of our present knowledge toward total hysterectomy in nonmalignant conditions of the uterus aim to benefit and protect our patients against cancer. RICARDO
Ramirez, D.: Vaginal Atresia: Its Transplant, Personal Technique
L.
Treatment by the Use of Heteropls&ic of the Author, Ginec. y obst. de Mexico
of cases. the presshows a
GORBEA
HomOlogOuS 8: 22,
1953.
The author introduces his paper with a resume of embryologic considerations and historical data on vaginal atresia. He then presents the case of a 24-year-old white woman, married, with vaginal agenesia. There were no anomalies found in the urinary tract. Following the author’s personal and original technique, a vagina was built using homologous tissue transplants from another woman who was operated upon 20 minutes before for second-degree uterine prolapse. Blood groups and Rh factors were similar in both patients. The patient was hospitalized 19 days, and within 45 days was able to have sexual intercourse. Six months later the vagina was 7 cm. in depth. The grafted tissues were cytologically studied then and it was found that both the basal and stratified layers retained their normal characteristics. Within a year the patient was able to attain perfect sexual libido. It is the opinion of the author that the success of this operation was due to the fact that both patients had similar blood and Rh groups, both had good ovarian function, and postoperatively antibiotics and estrogens were used for two weeks. The author has inserted numerous diagrams and roentgenograms to illustrate his technique. The bibliography contains 28 references. RICARDO
Cuaresma Gutierrez, C.: ation, Ginec. y obst.
Prevention de Mexico
of Bladder Dysfunction
Following
L.
GORBEA
the Wertheim
Oper-
8: 36, 1953.
The author reports on the frequent postoperative complication of primary retention followed by incontinence after a radical Wertheim hysterectomy. He feels that this is due to partial parasympathetic denervation of the bladder brought about by the operative procedure, together with mechanical extirpation of most of the bladder supports. The author has followed a postoperative as well as operative finale which has helped prevent these complications. He diminishes the bladder capacity by applying 3 concentric pursestring sutures in the posterior denuded portion of the bladder which has been left without any support. He peritonizes this portion with the vesicouterine fold and also covers the raw area anterior to the rectum, thus forming a cul-de-sac of Douglas similar to that of the male. He leaves a retention catheter of four to eight days and follows this with injection of 30 C.C. of Mereurochrome to stimulate vesical contractility. Early ambulation is enforced and the use of antibiotics is carried on until there is no evidence of infection. RICAIDO
Labor, Gibson, George B.:
Surgical
Induction
L.
GORBEA
Management of Labour,
J. Obst.
& Gynaec.
Brit.
Emp.
59:
Dec.,
1952. Presented are the results of 843 consecutive cases occurring from 1946 to 1950, in which surgical induction of labor was performed, an incidence of 9.9 per cent. In the series, -168 were primigravidas and the average age was 29$$ years. A review of the indications reveals that 833 had a definite complication, with pre-eclampsia occurring in 635, accidental previa in 27, intrauterine death in 19, erythhemorrhage in 61, hydramnios in 28, placenta roblastosis in 19, etc. Only 10 were performed for convenience, in contrast to American
descriptions of eosinophilic granuloma disease, and Letterer-Siwe disease are and clinical evidence indicates that all of the same basic disease process.
Therapy palliation.
is
inadequate
hut
roentgen
treatment
of skin and bone, Hand-Schiillergiven. The authors believe that the of these conditions are reall,v different or
local
excision ROBERT
Barns,
may
yield
good
B. WILSON
Tom, and Snaith, Linton M.: Tuberculous Cervicitis; A Report on Two Cases and a Note Upon the Natural History of the Condition, .T. Obst. & Gynaec. Brit. Emp. 60: Xl,
1953.
Two
cases of tuberculous cervicitis are described. The first occurred in a E-year-old patient who had a premature labor following an antepartum hemorrhage at 30 weeks’ gestation. Pulmonary tuberculosis was unrecognized in her antepartum course but subsequently serial x-rays were regarded as evidence that a very early tuberculous lesion of the lung developed during pregnancy. Six weeks post partum a persistent low-grade fever was observed and examination revealed a right-sided tubal mass. Diagnostic curettage and cervical biopsy revealed typical miliary tuberculosis in the endometrium and cervix and on bacteriological examination tubercle bacilli were recovered from the endometrium. The second patient was a 25-year-old woman who developed a pleural effusion at 24 years of age. During the time of the pleural effusion, the patient’s menses underwent striking alterations from a 28 day cycle lasting 6 days to a 35 day cycle lasting 11 days. Pelvic examination revealed a florid, proliferative mass growing from the cervix, which bled Dilatation and curettage and cervical biopsy readily and was hard, irregular, and painless. revealed tuberculous endometritis and cervicitis. The authors believe that female genital tuberculosis develops during the phase of bacteremia which is known to occur during and for a short time after the development of the primary tuberculous focus. They state that owing to the rarit,y with which the appear that genital tuberculosis is primary infection occurs after the age of 20, it would however long it may remain latent before discovery essentially a disease of adolescence, in later life. GEORGE HCH.~EFER
Gynecologic
Operations
deMorales, Arnaldo : Indications for Total Hysterectomy the Uterus, Arq. de clin. ginec. 4: 11, 1951.
in Nonmalignant
Conditions
of
After reviewing the literature of the last decade where the indications for total hysterectomy in nonmalignant conditions of the uterus are discussed, and the advantages of total over subtotal hysterectomy in these eases are emphasized, the author quotes the statistics reported by the different clinics on the incidence of cancer of the cervical stump and the results of vaginal and abdominal total hysterectomy. Reporting on his experiences in Brazil where he has, for a long time, advocated hysterectomy in the treatment of nonmalignant conditions of the uterus in women menopause or postmenopausal period, primarily for the prevention of cancer, he figures obtained in his gynecological clinic where a c.onservative policy for the group of women is followed, although total hysterectomy is usually indicated for ones. Twelve cases of cancer of the cervical stump, after subtotal hysterectomy, served in his clinic.
total at the cites the younger the older were ob-
It is obvious that no procedure in any clinic. may be considered as a constant routine. There are indications for vaginal hysterectomy as well as for abdominal hysterectomy. be the method of choice, since it excludes Total hysterectomy, in the latter cases, should the danger of an infected or cancerous cervix.
Volume 67 Number 1
Total The author ent trend continuing
SELECTEL,
217
AHSTRACTS
hysterectomy has advantages which advocate its use in the majority feels satisfied, therefore, that in the light of our present knowledge toward total hysterectomy in nonmalignant conditions of the uterus aim to benefit and protect our patients against cancer. RICARDO
Ramirez, D.: Vaginal Atresia: Its Transplant, Personal Technique
L.
Treatment by the Use of Heteropls&ic of the Author, Ginec. y obst. de Mexico
of cases. the presshows a
GORBEA
HomOlogOuS 8: 22,
1953.
The author introduces his paper with a resume of embryologic considerations and historical data on vaginal atresia. He then presents the case of a 24-year-old white woman, married, with vaginal agenesia. There were no anomalies found in the urinary tract. Following the author’s personal and original technique, a vagina was built using homologous tissue transplants from another woman who was operated upon 20 minutes before for second-degree uterine prolapse. Blood groups and Rh factors were similar in both patients. The patient was hospitalized 19 days, and within 45 days was able to have sexual intercourse. Six months later the vagina was 7 cm. in depth. The grafted tissues were cytologically studied then and it was found that both the basal and stratified layers retained their normal characteristics. Within a year the patient was able to attain perfect sexual libido. It is the opinion of the author that the success of this operation was due to the fact that both patients had similar blood and Rh groups, both had good ovarian function, and postoperatively antibiotics and estrogens were used for two weeks. The author has inserted numerous diagrams and roentgenograms to illustrate his technique. The bibliography contains 28 references. RICARDO
Cuaresma Gutierrez, C.: ation, Ginec. y obst.
Prevention de Mexico
of Bladder Dysfunction
Following
L.
GORBEA
the Wertheim
Oper-
8: 36, 1953.
The author reports on the frequent postoperative complication of primary retention followed by incontinence after a radical Wertheim hysterectomy. He feels that this is due to partial parasympathetic denervation of the bladder brought about by the operative procedure, together with mechanical extirpation of most of the bladder supports. The author has followed a postoperative as well as operative finale which has helped prevent these complications. He diminishes the bladder capacity by applying 3 concentric pursestring sutures in the posterior denuded portion of the bladder which has been left without any support. He peritonizes this portion with the vesicouterine fold and also covers the raw area anterior to the rectum, thus forming a cul-de-sac of Douglas similar to that of the male. He leaves a retention catheter of four to eight days and follows this with injection of 30 C.C. of Mereurochrome to stimulate vesical contractility. Early ambulation is enforced and the use of antibiotics is carried on until there is no evidence of infection. RICAIDO
Labor, Gibson, George B.:
Surgical
Induction
L.
GORBEA
Management of Labour,
J. Obst.
& Gynaec.
Brit.
Emp.
59:
Dec.,
1952. Presented are the results of 843 consecutive cases occurring from 1946 to 1950, in which surgical induction of labor was performed, an incidence of 9.9 per cent. In the series, -168 were primigravidas and the average age was 29$$ years. A review of the indications reveals that 833 had a definite complication, with pre-eclampsia occurring in 635, accidental previa in 27, intrauterine death in 19, erythhemorrhage in 61, hydramnios in 28, placenta roblastosis in 19, etc. Only 10 were performed for convenience, in contrast to American