Menorrhagia and metrorrhagia due to certain benign diseases of the uterus, and their treatment by irradiation

of carbon dioxide at a pressure of 80 mm. After I liter of gas was thus introduced into the peritonea cavity, 2 C.C. of Iipioclol were injected into the uterus through the same cannuln. The patient was then pIaced in the partial kncechest posture and stereoroentgenograms were made. It was found that both tubes admit& IipiodoI through their entire Iength nnd there \\:\s no tuba1 pnthoIogic change. The right ovary was cystic, about 7 cm. in diameter and aclhercnt to the bowe1. These adhesions were clearly visible. BOWING, IIARRY H. Menorrhagia and metrorrhagia due to certain benign diseases of the uterus, and their treatment by irradiation. Rudiolo~~t, September, 1926, vii, 234-241. When radium is avniIabIe and can be applied tlirectl\. to the uterinew& kvwavofthc uterine canal, ft is the method of &oicC. It should be s upplcmentcd with roentgen-ray treatment when the fundus is Inrger than n five or six months pregnancy. When radium is not avnilable, roentgen rays used nIone are effective and x a rule must be repeatedly appIied for some months. A thorough clinical examination and opcrntivc treatment where indicated arc esscntinl. The mental state of the patient :shouId not be ignoretl.. The results of radium treatment at the Mayo Clinic hnvc been generaIIy satisfactory, because the casts lvcrc carefulIy seIected and therapy \V:ISjudiciously appIied. When small and moclcrate doses of radium are used, it may be necessary to repcat them from time to time with an inter\.4 of several months eIapsing between treatments. Provided the risk is not great, an operation is better than repeated applications f radium. ‘) 7‘1le resuIt rn?y occur immediateiy or after :~n interval of SIS or eight weeks. In some a gradual Iessening of the quantity of the fIow is noted. A few patients report an excessive fIow at the period folIowing the apphcntion of radium. When Inrge fibromyomas are present, man\ months arc required for their reduction. The dose of raclium radiation in these cases was smal!, modcrate or Iarge, depending on the condition. The smal1 dose consisted of 200 to 300 lug-hr.; moderate, 300 to 000 mg-hr.; and the large dose (the menopause dose) varied from 700 to 1200 mg-hr. The suppIementary rocntgcn treatment had the following dose factors: 200 kv., 5 ma., 0.75 mm. Cu plus 2.0 mm. Al, 50 cm. distance, two 20 X 20 cm. fieIds, one on the anterior abdomen and one posterior, one hour esposure for each field. Fibromyomas require only one treatment when the uterus is of the size of a five or six months’ pregnancy; but if the size shouId be greater the treatment

may bc repeated. value of further supervenes.

The author questions the treatment if amenorrhea

L1~1.4~ li. P. The reaction of the tissues to radium in treatment in cancer of the cervix and the importnncc or’ l:\ccr-ations in producing cancer in this location. Surg., (;L’[email protected]., Dcccmber, 1926, xliii, -ro 723.

FAIW.41<,

In the cervix, the reaction to racl;um trcatment is so nearIy uniform that the appearance of the cervix each month nftcr trcattncnt CYIII bc predicted if the cast is progressing I‘:~vor:ibl,v; one can also teI1 when the mlsimurn cffcct 01 radium has been renchcd ant1 a furtllcr. (lose is needed. Cancer of the cer\-i\: when trcatctl by radium shows a progressive course to\v:\rcl contraction of the ccrvis 2nd inhil)ition 01‘tllc cnnccr cells in well-cletincrl stages of c,I) hy[)cremia; (2) slough; (3) healing, ant1 (4) c,ontrac.tion. One \veck al’tcr t tic iniStage of flyperenzia. tial dose of radium the tissues 01‘ the ccr\,i*: arc intensely red and hyperemic. The I)lood \-cssels are engorged with J~loocI and it is I.or this reason that the author dots not consider the case shouIc1 be irradiated if an inimecliate operation is imperative. One month after irradiation Stage oj”Slough. the cervix usualIy shows an cxtcnsivc green sIough and a foul discharge !‘rom the I)rokendown carcinoma. This slough must l)e entirely scr>nratcd from the cervix bcl;)rc :t hvstcrecto;uy can be performed without great dnngcr of peritonitis resulting from cutting into t’his necrotic tissue. It is cmplinsizcd that not cvcry case progresses at the same rate 01’ spectl, CL’CII when CnvorabIe results are 0bt:ririctl. This is reacl1ccl usually Stage 0J Healing. two months after irradiation. Tlir: appcarancc of the cervix is now completely changctl as the slough has separated leaving :I smoolh, clean, dusky red cervix which ni:ly IX somewhat gIazed but has clinically no ~I~CIICW of carcinoma. This is IbIIo~~ecI 1~~ a sta,qr (!f contraction in about a month. The dc\ c4opment of conncctiT,c tissue which is c\;citccl 1)~ irrndintion markcclly reduces the siylc of the cer\,ix and also the \:ault of the v:lgin:r. Large carcinomatous growths or even cr:iters become contracted to a normal or smailcr that1 normal cervix and the vault is as narrow as that seen in seniIe vaginitis. FoIlowing this occurs the ,/inct1 stuge, that of marked corztractiou. The increasing amount of connective tissue squcczcs the tissues of the cervix until the Intter is f~rially so shrunken as to Ieave a supcrficinl rescml,lnncc to an amputated organ. Littlc or no vault to the vagina is left and the mucous rticnll,rane is pale, with only an occasional I~lood \-esscl in sight. It is only when this stage is rcachecl that