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NORTH OF ENGLAND OBSTETRICAL AND GYNECOLOGICAL SOCIETY
1054 to a testicle being brought down was not shortness of the vessels but adhesions between the vas and the
peritoneum. Mr. W. McADAM ECCLES
urged
that the term
" undescended testicle " should be abandoned in favour of " imperfectly migrated " testicle. Much had still to be learnt about this subject, and he felt that the greatest help would be obtained from the experience of medical officers to schools. Mr. T. W. MIMPRISS gave the post-operative records of 80 cases treated by the Bevan technique at St. Thomas’s Hospital. Only half of these operative results could be said to be satisfactory. Better results were noted with the transeptal technique and although there were as yet an insufficient number of cases available, it looked as if the Keetley-Thorek technique was going to give the best results of all. He was sceptical of the action of gonadotropic hormone. Dr. RONALD SMITH (Rugby School) said that imperfectly descended testicle was extremely common amongst schoolboys. Contrary, however, to Prof. Grey Turner’s belief, a very large number of these testicles descended spontaneously before puberty. He therefore recommended that all cases be left till puberty before an operation was undertaken.
NORTH OF ENGLAND OBSTETRICAL AND GYNECOLOGICAL SOCIETY MEETING of this society was held in Sheffield April 2nd with Dr. J. W. BRIDE (Manchester), the president, in the chair. Labour Obstructed by Fcetal Bladder Dr. F. J. BURKE (Liverpool) gave an account of a case of dystocia due to over-distension of the foetal
A
on
bladder. The patient, a multipara aged 29, went into labour at 9 P.M. on Jan. 27th, being about 35 weeks’ pregnant. At midnight the head and hands of the foetus were born but there was no further progress. When admitted to hospital she was having strong pains and was acutely distressed. The fundus reached to midway between the umbilicus and the ensiform cartilage, and no foetal heart could be heard. A foetal head and two hands were protruding through the vulva. The foetal neck was long and the cervical spine was fractured-no doubt through vigorous traction by a practitioner who had been called in by the midwife. The thorax was found tightly plugged in the maternal pelvis, and an incision was made through the foetal chest wall. A large quantity of fluid escaped and delivery was soon completed. The foetus weighed 6 lb. and was considerably elongated, with the abdominal wall in large folds ; there was also bilateral talipes equinovarus. Post mortem the bladder in its collapsed condition measured 6 in. by 4 in. and had hypertrophied walls. Both ureters were dilated and the kidneys enlarged. The urethra was patent, a small catheter passing without
difficulty. Dr. Burke said that several similar cases of distension of the foetal bladder with patency of the urethra had been described, and he quoted those of Savage and Crawford and Jeffcoate. Neuromuscular dysfunction was the usual explanation of the failure of the foetal bladder to empty itself. He also wondered what part was played by the foetal kidneys in the production of liquor amnii. Gaylord Bates had pointed out the frequent association of oligohydramnios and foetal renal anomalies. The biochemical studies of Makepiece Smith and Carroll strongly suggested that the liquor amnii was a
transudate which, in early pregnancy, was in isometric equilibrium with maternal and foetal blood, but in late pregnancy was hypotonic because of the addition of foetal urine. On the other hand, there was evidence that the foetal kidneys did not subscribe to the liquor amnii. Phloridzin injected into the mother could be readily detected in the foetal tissues, but it was rare to find even a trace of sugar in the liquor amnii. The PRESIDENT said that the condition seemed always to be associated with obstruction to the urethra, and that he supposed it was more common in the male foetus.—Mr. J. E. STACEY referred to the elongation of the cervical vertebrae and the talipes equinovarus, and wondered whether the condition was associated with any spinal lesion.-Dr. BURKE, in reply, said he had no doubt that the elongation of the cervical vertebrse was produced by trauma.
Adenomyoma Causing Mr. A. GOUGH an
adenomyoma
Intestinal Obstruction
(Leeds) described a case responsible for acute
was
in which intestinal
obstruction. The patient, aged 42, had never been pregnant. She had had gradually increasing constipation for six months, culminating in complete obstruction. The day before Mr. Gough saw her, she had had absolute constipation as regards both faeces and flatus, and had vomited once. Her general condition was quite good, and there was a tense rounded swelling in the hypogastrium the size of a four months’ pregnancy. On vaginal and rectal examination a hard fixed mass was felt behind the uterus and involving the upper part of the rectum. On opening the abdomen the rounded swelling was found to be a chocolate cyst of the left ovary. There was much indurated tissue involving the cervix and the upper part of the rectum. A diagnosis of adenomyoma was made, and later confirmed by histological examination. A colostomy was performed, after the bulk of the disease had been removed, including both ovaries and the uterus. A fortnight later, Mr. Gough was able to start making a way through the obstructed bowel, by passing gum elastic bougies up the rectum. These were followed later by rectal tubes passed from the colostomy downwards. In a fortnight the passage had been dilated to ! in. The colostomy was closed in stages by the use of an enterotome. Six days later the bowel was dissected from the abdominal wall and the wound closed. Some leakage occurred but within three weeks the fsecal fistula had closed.
Mr. GouGH said that an acute obstruction due to adenomyoma must be very rare indeed.-The PRESIDENT said it was quite clear that the adenomyoma was in the bowel wall, and not merely in the rectovaginal space.-Prof. LEYLAND ROBINSON (Liverpool) remarked that the case showed how important it was that a gynaecologist should have a knowledge of general surgery. an
Dr. GLADYS KAY gave a demonstration of X ray films taken of pregnant women during the antsnatal period. The PRESIDENT, Prof. A. M. CLAYE (Leeds), Mr. J. E. STACEY (Sheffield), and Mr. T. F. TODD (Manchester) took part in the discussion. SALFORD ROYAL HOSPITAL.-Extensions and alterations to this hospital, though not quite finished, were opened on April 12th. The ceremony took place in the new Bernhard Baron orthopaedic department, for which the trustees of the late Mr. Baron have given The erection of a new casualty the sum of 3000. department and the enlargement of the out-patients’ accommodation have been made possible by a donation of i8000 from the Lancashire and Cheshire Miners’ Welfare Fund. The hospital’s deficiency on capital account now stands at 24,498.
peritoneum. Mr. W. McADAM ECCLES
urged
that the term
" undescended testicle " should be abandoned in favour of " imperfectly migrated " testicle. Much had still to be learnt about this subject, and he felt that the greatest help would be obtained from the experience of medical officers to schools. Mr. T. W. MIMPRISS gave the post-operative records of 80 cases treated by the Bevan technique at St. Thomas’s Hospital. Only half of these operative results could be said to be satisfactory. Better results were noted with the transeptal technique and although there were as yet an insufficient number of cases available, it looked as if the Keetley-Thorek technique was going to give the best results of all. He was sceptical of the action of gonadotropic hormone. Dr. RONALD SMITH (Rugby School) said that imperfectly descended testicle was extremely common amongst schoolboys. Contrary, however, to Prof. Grey Turner’s belief, a very large number of these testicles descended spontaneously before puberty. He therefore recommended that all cases be left till puberty before an operation was undertaken.
NORTH OF ENGLAND OBSTETRICAL AND GYNECOLOGICAL SOCIETY MEETING of this society was held in Sheffield April 2nd with Dr. J. W. BRIDE (Manchester), the president, in the chair. Labour Obstructed by Fcetal Bladder Dr. F. J. BURKE (Liverpool) gave an account of a case of dystocia due to over-distension of the foetal
A
on
bladder. The patient, a multipara aged 29, went into labour at 9 P.M. on Jan. 27th, being about 35 weeks’ pregnant. At midnight the head and hands of the foetus were born but there was no further progress. When admitted to hospital she was having strong pains and was acutely distressed. The fundus reached to midway between the umbilicus and the ensiform cartilage, and no foetal heart could be heard. A foetal head and two hands were protruding through the vulva. The foetal neck was long and the cervical spine was fractured-no doubt through vigorous traction by a practitioner who had been called in by the midwife. The thorax was found tightly plugged in the maternal pelvis, and an incision was made through the foetal chest wall. A large quantity of fluid escaped and delivery was soon completed. The foetus weighed 6 lb. and was considerably elongated, with the abdominal wall in large folds ; there was also bilateral talipes equinovarus. Post mortem the bladder in its collapsed condition measured 6 in. by 4 in. and had hypertrophied walls. Both ureters were dilated and the kidneys enlarged. The urethra was patent, a small catheter passing without
difficulty. Dr. Burke said that several similar cases of distension of the foetal bladder with patency of the urethra had been described, and he quoted those of Savage and Crawford and Jeffcoate. Neuromuscular dysfunction was the usual explanation of the failure of the foetal bladder to empty itself. He also wondered what part was played by the foetal kidneys in the production of liquor amnii. Gaylord Bates had pointed out the frequent association of oligohydramnios and foetal renal anomalies. The biochemical studies of Makepiece Smith and Carroll strongly suggested that the liquor amnii was a
transudate which, in early pregnancy, was in isometric equilibrium with maternal and foetal blood, but in late pregnancy was hypotonic because of the addition of foetal urine. On the other hand, there was evidence that the foetal kidneys did not subscribe to the liquor amnii. Phloridzin injected into the mother could be readily detected in the foetal tissues, but it was rare to find even a trace of sugar in the liquor amnii. The PRESIDENT said that the condition seemed always to be associated with obstruction to the urethra, and that he supposed it was more common in the male foetus.—Mr. J. E. STACEY referred to the elongation of the cervical vertebrae and the talipes equinovarus, and wondered whether the condition was associated with any spinal lesion.-Dr. BURKE, in reply, said he had no doubt that the elongation of the cervical vertebrse was produced by trauma.
Adenomyoma Causing Mr. A. GOUGH an
adenomyoma
Intestinal Obstruction
(Leeds) described a case responsible for acute
was
in which intestinal
obstruction. The patient, aged 42, had never been pregnant. She had had gradually increasing constipation for six months, culminating in complete obstruction. The day before Mr. Gough saw her, she had had absolute constipation as regards both faeces and flatus, and had vomited once. Her general condition was quite good, and there was a tense rounded swelling in the hypogastrium the size of a four months’ pregnancy. On vaginal and rectal examination a hard fixed mass was felt behind the uterus and involving the upper part of the rectum. On opening the abdomen the rounded swelling was found to be a chocolate cyst of the left ovary. There was much indurated tissue involving the cervix and the upper part of the rectum. A diagnosis of adenomyoma was made, and later confirmed by histological examination. A colostomy was performed, after the bulk of the disease had been removed, including both ovaries and the uterus. A fortnight later, Mr. Gough was able to start making a way through the obstructed bowel, by passing gum elastic bougies up the rectum. These were followed later by rectal tubes passed from the colostomy downwards. In a fortnight the passage had been dilated to ! in. The colostomy was closed in stages by the use of an enterotome. Six days later the bowel was dissected from the abdominal wall and the wound closed. Some leakage occurred but within three weeks the fsecal fistula had closed.
Mr. GouGH said that an acute obstruction due to adenomyoma must be very rare indeed.-The PRESIDENT said it was quite clear that the adenomyoma was in the bowel wall, and not merely in the rectovaginal space.-Prof. LEYLAND ROBINSON (Liverpool) remarked that the case showed how important it was that a gynaecologist should have a knowledge of general surgery. an
Dr. GLADYS KAY gave a demonstration of X ray films taken of pregnant women during the antsnatal period. The PRESIDENT, Prof. A. M. CLAYE (Leeds), Mr. J. E. STACEY (Sheffield), and Mr. T. F. TODD (Manchester) took part in the discussion. SALFORD ROYAL HOSPITAL.-Extensions and alterations to this hospital, though not quite finished, were opened on April 12th. The ceremony took place in the new Bernhard Baron orthopaedic department, for which the trustees of the late Mr. Baron have given The erection of a new casualty the sum of 3000. department and the enlargement of the out-patients’ accommodation have been made possible by a donation of i8000 from the Lancashire and Cheshire Miners’ Welfare Fund. The hospital’s deficiency on capital account now stands at 24,498.