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Pütz, T.: Extrauterine Pregnancy
Department of Reviews and Abstracts CONDUCTED BY HUGO EHRENFEST,
M.D.
Selected Abstracts Extrauterine Pregnancy Piitz, T.: Extrauterine Pregnancy, Monatschr. f. Geburtsh. u. Gynak. 104: 57, 1936. The author studied a series of 300 cases of ectopic pregnancy. He believes the chief cause is to be found in inflammatory changes of the genitalia. Helpful procedures in making a diagnosis are as follows: (1) The white blood count and the sedimentation test, (2) bimanual examination under evipal, (3) puUGture of the cul-de-sac of Douglas, (4) exploratory curettement of the uterus, (5) the Aschheim-Zondek pregnancy test, and (6) exploratory laparotomy. In the author's clinic, every patient with an ectopic gestation is operated uvon as soon as the diagnosis is made. The operation is usually limited to removal of the involved tube. 'l'he death rate in this series was 2 per cent. J. P. GREENHILL Nixon, W. C. W.: Aids in the Diagnosis and Treatment of Ectopic Gestation, Brit. M. J. 2: 579, 1937. In the diagnosis of ectopic gestation one must evaluate carefully the history, symptoms, and signs. The history of recurrent attacks of low abdominal pain, accompanied by periodic or continuous uterine bleeding, is very signiiicant. Pulsation in one or other fornix is always present and confirms the diagnosis. It is felt best at the junction of the vagina and cervix by gentle palpation. Puncture of the posterior fornix is a useful aid in diagnosis, if doubt exists, in the acute tubal rupture type. Treatment is operative in all cases of hematocele, no matter how small it is and irrespective of how ill or well the patient appears to be. Drainage should be avoided. The author favors autotransfusion in the acute cases, where there is free intraperitoneal bleeding and absence of infectum. The abdominal route should be employed in all cases in the absence of infection. Where, however, an hematocele has become infected and a pelvic abscess is present, drainage through the posterior vaginal fornix is the method of choice. Seven cases of diverse type are reported. F. L. ADAm AND S. A. PEARL Hope, Robert B.: The Differential Diagnosis of Ectopic Gestation by Peritoneoscopy, Surg. Gynec. Obst. 64: 229, 1937. The diagnosis of ectopic gestation is not always simple. In the differential diagnosis, peritoneoscopy is a valuable adjunct. It is a safe procedure and in cases of actual intrauterine pregnancy, an abortion is far less likely to occur after it than after exploratory laparotomy. In questionable cases peritoneoscopy can be used to determine by direct eye· control whether surgery or expectant treatment is indicated. Ten case histol·ies are presented to show the procedure in this field. WILLIAM C. HENSKE. Siddall, R. S., and Jarvis, Charles: Uterine Curettage as an Aid in the Diagnosis of Ectopic Pregnancy, Surg. Gynec. Obst. 65: 820, 1937. In view of the frequent difficulties met with in the recognition of ectopic pregnancy, a study was made of uterine curettage as a iliagnostic aid. The pro· 723
M.D.
Selected Abstracts Extrauterine Pregnancy Piitz, T.: Extrauterine Pregnancy, Monatschr. f. Geburtsh. u. Gynak. 104: 57, 1936. The author studied a series of 300 cases of ectopic pregnancy. He believes the chief cause is to be found in inflammatory changes of the genitalia. Helpful procedures in making a diagnosis are as follows: (1) The white blood count and the sedimentation test, (2) bimanual examination under evipal, (3) puUGture of the cul-de-sac of Douglas, (4) exploratory curettement of the uterus, (5) the Aschheim-Zondek pregnancy test, and (6) exploratory laparotomy. In the author's clinic, every patient with an ectopic gestation is operated uvon as soon as the diagnosis is made. The operation is usually limited to removal of the involved tube. 'l'he death rate in this series was 2 per cent. J. P. GREENHILL Nixon, W. C. W.: Aids in the Diagnosis and Treatment of Ectopic Gestation, Brit. M. J. 2: 579, 1937. In the diagnosis of ectopic gestation one must evaluate carefully the history, symptoms, and signs. The history of recurrent attacks of low abdominal pain, accompanied by periodic or continuous uterine bleeding, is very signiiicant. Pulsation in one or other fornix is always present and confirms the diagnosis. It is felt best at the junction of the vagina and cervix by gentle palpation. Puncture of the posterior fornix is a useful aid in diagnosis, if doubt exists, in the acute tubal rupture type. Treatment is operative in all cases of hematocele, no matter how small it is and irrespective of how ill or well the patient appears to be. Drainage should be avoided. The author favors autotransfusion in the acute cases, where there is free intraperitoneal bleeding and absence of infectum. The abdominal route should be employed in all cases in the absence of infection. Where, however, an hematocele has become infected and a pelvic abscess is present, drainage through the posterior vaginal fornix is the method of choice. Seven cases of diverse type are reported. F. L. ADAm AND S. A. PEARL Hope, Robert B.: The Differential Diagnosis of Ectopic Gestation by Peritoneoscopy, Surg. Gynec. Obst. 64: 229, 1937. The diagnosis of ectopic gestation is not always simple. In the differential diagnosis, peritoneoscopy is a valuable adjunct. It is a safe procedure and in cases of actual intrauterine pregnancy, an abortion is far less likely to occur after it than after exploratory laparotomy. In questionable cases peritoneoscopy can be used to determine by direct eye· control whether surgery or expectant treatment is indicated. Ten case histol·ies are presented to show the procedure in this field. WILLIAM C. HENSKE. Siddall, R. S., and Jarvis, Charles: Uterine Curettage as an Aid in the Diagnosis of Ectopic Pregnancy, Surg. Gynec. Obst. 65: 820, 1937. In view of the frequent difficulties met with in the recognition of ectopic pregnancy, a study was made of uterine curettage as a iliagnostic aid. The pro· 723