- Email: [email protected]
Recent trends in hysterectomy in gynecological and obstetrical practice
Volume 76 Number 2
SELECTED
previously for it was not until great enough to force the fluid The author then discusses other membranes: 1. The so-called stitution which may or infarction of the
ABSTRACTS
the onset of labor that between the membranes causes of amniotic fluid
45!) the intrauterine pressure and the decidua to the leakage with gross rupture
“high leak” or rupture of the amnioehorion arise secondary to the trauma of attempted membranes, or markedly elevated intrauterine
2. The “double” or “split” sae with the separation Fluid passes through the permeable amnion and drains the more friable chorion.
with subsequent recef~abortion, coitus, infectiorl, pressures.
of the amnion to the outside
from the via minor
LAURENCE
The Canadian Vol. 78, 19.58. Swyer, Paul IL, and Weight,
John:
Medical
Association
The Control
beeawe outsidr. of the
chorion. tears in
SONDERS
Journal
of Supplemental
Oxygen by Oximetry,
p. 231. This paper describes experience in the control of supplemental oxygen with the we of the diamagnetic oxygen analyzer and the Wood speetrophotometric ear osimeter in the assessment of arterial oxygen saturation. The 31 patients investigated were receiving supplemental oxygen on the clinical grounds of cyanosis of central origin or dyspnea or both. In 14 patients receiving supplemental oxygen on clinical grounds, the arterial oxygen saturation was above 95 per cent when they were removed from oxygen and tested in air. They were probably receiving oxygen unnecessarily. In 14 cases there was less than 95 per cent saturation at the first examination. A significant proportion of these patients required more than 46 per cent oxygen initially to achieve an approximately normal arterial oxygen saturation. The tendency was for the need for supplemental oxygen to drop progressively with the passage of time. So surviving infant required supplemental oxygen for longer than 5 days. It was felt that if an infant’s blood can be shown to be 95 to 98 per cent saturated oximetrically, the arterial oxygen tension is not likely to be at dangerous levels. With approximately 96 per cent arterial saturation measured by ear oximeter, the partial PVHsure of oxygen in arterial blood will remain close to the safe 100 mm. Hg level. Oximetry can be used to control administration of supplemental oxygen at the miuimum level necessary to secure oxygenation of arterial blood and avoid hyperoxia in infant,s in the weight groups susceptible to retrolental fibroplasia, and hypoxia due to adherenl*e to a rigid rule-of-thumb limitation of supplemental oxygen. JOHN 5. DETTLINI;
Douglas, R. G., Buchman, M. L., and MacDonald, I?. A.: in Gynecological and Obstetrical Practice, p. 1065.
Recent Trends
in Hysterectomy
Recent trends in hysterectomy were discussed as they occurred at the New York Lying-In Hospital between the years 1950 and 1956, when 3,233 hysterectomies were pcrformed. Of the operations performed, 74.9 per cent were total abdominal in type; 3.7 per cent were subtotal; 18.2 per cent were vaginal; and 3.2 per cent were radical procedures. After 1946, there was a rapid reversal from subtotal to total hysterectomy. The incidence of vaginal hysterectomy has almost doubled since 1959. The median age of the patients who had abdominal hysterectomies was 45.3 years: whereas for those who had vaginal hysterectomies it was 54.6 years. The anesthesia of choice was general anesthesia with thiopentone induction, followed by nitrous osideoxygen-ether or cyclopropane. Myomas were the most frequent indication for the abdominal operation, and prolapse of the uterus for the vaginal procedure. The technique employed in total abdominal
460
SELECTED
.\rn. .I. ChL L tiyne A,lgusL. 195x
ABSTRACTS
hysterectomy is a modification of either the Richardson or the Aldridge method, except when adenocarcinoma is present. A variation of either the Heaney or Bissell-Goffe technique is used for vaginal hysterectomies. Postoperative complications were recorded in 49.6 per cent of the patients. One out of 5 patients developed urinary tract complications and next, amounting to 16.3 per cent, were temperature elevations of undetermined etiology. Antibiotics were employed in 74 per cent of the patients for prophylactic or therapeutic reasons. Cardiovascular complications included anemia, thrombophlebitis, hemorrhage, and hematoma. The pathological reports following hysterectomy disclosed that 64 per cent of the uteri contained myomas; 16.6 per cent contained endometrial polyps; 20.4 per cent exhibited atrophic endometrium; 6.2 per cent contained a malignant tumor of the cervix. The importance of routine cytological smears or a diagnostic dilatation and curettage prior to hysterectomy was stressed. The gross mortality rate was 0.3 per cent and the corrected rate was 0.15 per cent. JOHN
J. DETTLING
Cancer Research Vol.
18,
1958.
Donnelly, A. J., Havas, H. F., and Groesbeck, Ad. IX: XUxed Bacterial Toxins in the Treatment of Tumors. I. Methods of Preparation and Effects on Normal and Sarcoma 37-bearing Mice, p. 141. Normal and sarcoma 37-bearing mice were treated with varying strains of Streptoand Serratia marcescens, and combinations of strains of the two. Some cultures were grown separately and mixed before heat sterilization; in other preparations, the Serratia were inoculated into the growing Streptococcus culture at a specified time, depending on the type of preparation. Ascitic fluid containing sarcoma 37 was inoculated subcutaneously into mice, and after 7 days those with tumors of specific size were used in the experiment. Survival time, tumor size, and percentages of complete regressions were all considered as indices of efficacy. The final criterion of the effectiveness of the toxins, however, was the complete regression of the tumor at the completion of the experiment, and not simply a reduction in size of the tumor. Over 100 preparations comprising different strains of bacteria and modes of growth were tested. Each batch of toxins was tested in at least 32 mice. It was found that the mode of growth, as well as the bacterial strain, plays a determinant role in the ensuing oncolytic potency. From the regression rates it was found that some of the mixed preparations were less toxic than, and superior in oncolytic activity to, those from Serratia marcescens alone or its purified polysaceharide. Possible mechanisms responsible for tumor destruction discussed are: COCCUS
1. The gram-positive exotoxins from Streptococcus are mostly proteins which resemble enzymes. They might catalyze production of active hydrolytic enzymes from inactive precursors in the body or split off an active component from a less active precursor of the gram-negative Serratia. Synergistic effects can thus be produced which neither organism would achieve alone. 2. Tumor destruction might also be brought about by a modified Shwartzman reaction prepared and elicited by antigenically similar constituents of the tumor and bacterial cell. RICHARD J. CALAME
Donnelly, A. J., Haves, H. F., and Groesbeck, M. E.: Mixed Bacterial Toxins in the Treatment of Tumors. II. Gross and Miscropic Changes Produced in Sarcoma 37 and in Mouse Tissue, p. 149. given
The to
mixed normal
bacterial mice at
toxins relatively
(Streptococcus
high
dosages,
pyogenes produce
ard
Serratia
a nonspecific
maroescens),
alarm
when reaction.
SELECTED
previously for it was not until great enough to force the fluid The author then discusses other membranes: 1. The so-called stitution which may or infarction of the
ABSTRACTS
the onset of labor that between the membranes causes of amniotic fluid
45!) the intrauterine pressure and the decidua to the leakage with gross rupture
“high leak” or rupture of the amnioehorion arise secondary to the trauma of attempted membranes, or markedly elevated intrauterine
2. The “double” or “split” sae with the separation Fluid passes through the permeable amnion and drains the more friable chorion.
with subsequent recef~abortion, coitus, infectiorl, pressures.
of the amnion to the outside
from the via minor
LAURENCE
The Canadian Vol. 78, 19.58. Swyer, Paul IL, and Weight,
John:
Medical
Association
The Control
beeawe outsidr. of the
chorion. tears in
SONDERS
Journal
of Supplemental
Oxygen by Oximetry,
p. 231. This paper describes experience in the control of supplemental oxygen with the we of the diamagnetic oxygen analyzer and the Wood speetrophotometric ear osimeter in the assessment of arterial oxygen saturation. The 31 patients investigated were receiving supplemental oxygen on the clinical grounds of cyanosis of central origin or dyspnea or both. In 14 patients receiving supplemental oxygen on clinical grounds, the arterial oxygen saturation was above 95 per cent when they were removed from oxygen and tested in air. They were probably receiving oxygen unnecessarily. In 14 cases there was less than 95 per cent saturation at the first examination. A significant proportion of these patients required more than 46 per cent oxygen initially to achieve an approximately normal arterial oxygen saturation. The tendency was for the need for supplemental oxygen to drop progressively with the passage of time. So surviving infant required supplemental oxygen for longer than 5 days. It was felt that if an infant’s blood can be shown to be 95 to 98 per cent saturated oximetrically, the arterial oxygen tension is not likely to be at dangerous levels. With approximately 96 per cent arterial saturation measured by ear oximeter, the partial PVHsure of oxygen in arterial blood will remain close to the safe 100 mm. Hg level. Oximetry can be used to control administration of supplemental oxygen at the miuimum level necessary to secure oxygenation of arterial blood and avoid hyperoxia in infant,s in the weight groups susceptible to retrolental fibroplasia, and hypoxia due to adherenl*e to a rigid rule-of-thumb limitation of supplemental oxygen. JOHN 5. DETTLINI;
Douglas, R. G., Buchman, M. L., and MacDonald, I?. A.: in Gynecological and Obstetrical Practice, p. 1065.
Recent Trends
in Hysterectomy
Recent trends in hysterectomy were discussed as they occurred at the New York Lying-In Hospital between the years 1950 and 1956, when 3,233 hysterectomies were pcrformed. Of the operations performed, 74.9 per cent were total abdominal in type; 3.7 per cent were subtotal; 18.2 per cent were vaginal; and 3.2 per cent were radical procedures. After 1946, there was a rapid reversal from subtotal to total hysterectomy. The incidence of vaginal hysterectomy has almost doubled since 1959. The median age of the patients who had abdominal hysterectomies was 45.3 years: whereas for those who had vaginal hysterectomies it was 54.6 years. The anesthesia of choice was general anesthesia with thiopentone induction, followed by nitrous osideoxygen-ether or cyclopropane. Myomas were the most frequent indication for the abdominal operation, and prolapse of the uterus for the vaginal procedure. The technique employed in total abdominal
460
SELECTED
.\rn. .I. ChL L tiyne A,lgusL. 195x
ABSTRACTS
hysterectomy is a modification of either the Richardson or the Aldridge method, except when adenocarcinoma is present. A variation of either the Heaney or Bissell-Goffe technique is used for vaginal hysterectomies. Postoperative complications were recorded in 49.6 per cent of the patients. One out of 5 patients developed urinary tract complications and next, amounting to 16.3 per cent, were temperature elevations of undetermined etiology. Antibiotics were employed in 74 per cent of the patients for prophylactic or therapeutic reasons. Cardiovascular complications included anemia, thrombophlebitis, hemorrhage, and hematoma. The pathological reports following hysterectomy disclosed that 64 per cent of the uteri contained myomas; 16.6 per cent contained endometrial polyps; 20.4 per cent exhibited atrophic endometrium; 6.2 per cent contained a malignant tumor of the cervix. The importance of routine cytological smears or a diagnostic dilatation and curettage prior to hysterectomy was stressed. The gross mortality rate was 0.3 per cent and the corrected rate was 0.15 per cent. JOHN
J. DETTLING
Cancer Research Vol.
18,
1958.
Donnelly, A. J., Havas, H. F., and Groesbeck, Ad. IX: XUxed Bacterial Toxins in the Treatment of Tumors. I. Methods of Preparation and Effects on Normal and Sarcoma 37-bearing Mice, p. 141. Normal and sarcoma 37-bearing mice were treated with varying strains of Streptoand Serratia marcescens, and combinations of strains of the two. Some cultures were grown separately and mixed before heat sterilization; in other preparations, the Serratia were inoculated into the growing Streptococcus culture at a specified time, depending on the type of preparation. Ascitic fluid containing sarcoma 37 was inoculated subcutaneously into mice, and after 7 days those with tumors of specific size were used in the experiment. Survival time, tumor size, and percentages of complete regressions were all considered as indices of efficacy. The final criterion of the effectiveness of the toxins, however, was the complete regression of the tumor at the completion of the experiment, and not simply a reduction in size of the tumor. Over 100 preparations comprising different strains of bacteria and modes of growth were tested. Each batch of toxins was tested in at least 32 mice. It was found that the mode of growth, as well as the bacterial strain, plays a determinant role in the ensuing oncolytic potency. From the regression rates it was found that some of the mixed preparations were less toxic than, and superior in oncolytic activity to, those from Serratia marcescens alone or its purified polysaceharide. Possible mechanisms responsible for tumor destruction discussed are: COCCUS
1. The gram-positive exotoxins from Streptococcus are mostly proteins which resemble enzymes. They might catalyze production of active hydrolytic enzymes from inactive precursors in the body or split off an active component from a less active precursor of the gram-negative Serratia. Synergistic effects can thus be produced which neither organism would achieve alone. 2. Tumor destruction might also be brought about by a modified Shwartzman reaction prepared and elicited by antigenically similar constituents of the tumor and bacterial cell. RICHARD J. CALAME
Donnelly, A. J., Haves, H. F., and Groesbeck, M. E.: Mixed Bacterial Toxins in the Treatment of Tumors. II. Gross and Miscropic Changes Produced in Sarcoma 37 and in Mouse Tissue, p. 149. given
The to
mixed normal
bacterial mice at
toxins relatively
(Streptococcus
high
dosages,
pyogenes produce
ard
Serratia
a nonspecific
maroescens),
alarm
when reaction.