Karman catheter

Volume Number

Correspondence

115 4

longed periods of hospitalization. Thus, the author has discontinued the use of grasping the periurethral tissue with the Babcock clamp. Even though the patient may be quite stout, the use of deep Trendelenburg position and the placing of a Goulet retractor under the pubic bone will greatly facilitate good visualization of the operative field. However, it is most important that traction be placed from the site of the bladder neck with constant tension on the chromic 1-O suture that has been placed in the tissue on each side of the bladder neck. Tension is exerted cephalad, and the suture is placed into each side of the bladder neck1 at a distance of 4 cm. along the length of the urethra as measured by an orthopedic ruler placed in the space of Retzius. The author does not utilize the placing of fingers in the vagina, and there have been no incidents in which the periurethral sutures have penetrated the vagina. If such an occurrence should take place, it is doubtful it would lead to any adverse effects. Another valuable adjunct in placing the suture with facility and accuracy in the space of Retzius as well as in the pubic symphocele is the use of the Heaney needle holder. Edward B. Cantor, M.D. 4955 Van Nuys Blvd. No. 503 Sherman Oaks, California 91403

nancy but did not note the quantity of the retained material, without which its significance cannot be evaluated. Goldsmith and Margolisa had no such problems, while Lewis and colleagues4 reported retained tissue, primarily in their initial patients. This problem resolved itself with further experience and increased expertise. In carrying out an abortion procedure, great stress must be placed on efforts to decrease cervical trauma and subsequent cervical incompetence. Data from Eastern Europe,3 Japan,” and the United Kingdoms suggest an increase in premature labor subsequent to induced abortion. Narrow-diameter flexible cannulas can play an important role in early abortion and can be used into the ninth week of pregnancy (from the date of the last menstrual period) without problem. It is most important to the welfare of women that use be made of such minimum dilatation techniques in early abortion procedures. Alan J. Ma&is, M.D. Sadja Goldsmith. M.D. University of California, San Francisco School of Medicine Department of Obstetrics and Gynecology San Francisco, California 94122 REFERENCES

1. Beric, B, Kupresanin,

M., and Hulka, J. F.: 114: 273, 1972. Goldsmith, S., and Margolis, A. J.: AM. J. OBSTET. GYNECOL. 110: 580, 1971. Klinger, A.: Int. J. Gynaecol. Obstet. 8: 680, 1970. Lewis, S. C., Lal, S., Branch, B., and Beard, R. W.: Br. Med. J. 4: 606, 1971. Moriyama, Y., and Hirokawa, 0.: -Harmful effects of induced abortion, Report of studies conducted by Family Planning Federation of Japan, 1966. Wright, C. S., Campbell, S., and Beazley, J.: Lancet 1: 1278, 1972. AM.

2.

REFERENCE

1. Cantor, E. B.: J. Urol.

106: 867, 1972.

Karman catheter To the Editors: In their recent communication in brief on the Karman catheter, Beric and his coauthors1 ignored two recent paper& 4 on the use of this flexible cannula. They reported retention of tissue in large numbers of patients even early in preg-

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