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Salpingitis in elderly women
REVIEWS
AND
ABSTRACTS
“77
All operated eases were followed up aa to the effect on this particular syrr~ptom. Replies were received from 152 patients, of which 62 had had no backache since the operation. Forty-two were much improved and 41 were no better. Seventy-three per cent of backaches associated with a gynecologic abnormality were cured or much relieved by appropriate surgical treatment. The importance of backache in uncomplicated retroversion and retroflexion haa been much exaggerated, as it is found, almost as frequently, in cases where the uterus is in a forward position. The most important factor in produring backache is fatigue of muscles. Where there is a definite indication for surgical treatment the backache can be cured or much relieved in over seventy per cent of CRSI~S,the rpnu1t.s being especialI! good in cases of prolapse treated by colporrhaph~. NORMAN F. Mrra,c~. Huet: Rupture and Perforation of Pgosalpinx into the Peritoneal Cavity. Journal de ,Chirurgie, 1924, xxiii, 123. The frequency of ruptured pyosalpinx, as given by various authors, differs widely, but it, certainly cannot be classed as a rare occurrence. Rupture may be caused by direct trauma of some kind or may be due to the lighting up of an old infection. In the first type, there is found a distinct tear in the tubal wall, while in the second, the aperture is more of the nature of a perforation, being due to the formation of perforatire ulcers. In ten cases of rupture due to trauma there were only three deaths but in twelve perforations eight deaths. These perforations vary greatly in size and shape and often are surrounded by a necrotic zone. They are usually single but in one Case two openings were found. The rupture occurs most. frequently in the ampulla of the tube. The principal symptoms are severe pain, collapse, pallor, chills, and aeeeleratiou of pulse, followed by a steady rise in temperature, nausea and vomiting. The onset follows immediately the trauma in the cases of true rupture while in the cases of perforation the characteristic symptoms may not be present for several days. There is a marked rigidity of the abdomen with abdominal tenderness and lack of motion on respiration. Rupture of the bladder, ruptured appcndir and ruptured tubal pregnancy must be considered in the differential diagnosis. Where the diaguosis is made early, operatiuu is clearly indicated. If, however. the condition has progressed to the stage of abdominal dis:elltion, the prognosis is extremely poor. When the collection of pus is more or less loralized and low down in the pelvis a posterior colpotomy is the operation of choice. This, ho\\ever, implies the danger of leaving the infected tube as possible source of reinfection. Therefore, in those eases where laparotomy is necessary to reach the pus, he advocat?s a rcmoval of the tube. Following all such laparotomies he inserts a drain at the low\:c?l end of the incision down into the culdesac. THEODORE W. ADAMS. 111% Tixier and Rochet: Salpingitis in Elderly Women. Archives France-Belgcs Chirurgie, 1925, xxviii, 659. In patients from thirty-five to forty-five years of age salpingitis assumes an extremely grave aspect. It occurs unexpectedly both in women who have previously had,a genital infecticn, and in those in whom there is no tracae of previous infections pathology. In the latter type there often exists a source of latent infection such a?? In elderly women salpingitis is a degenerating fibroid or small local infections. cured but seldom by medical treatment and the prognosis is always poor even SO far as life is concerned. The treatment of choice is total hysterectomy as at this time of life the symptoms of postoperative menopause arc negligible. THEODORE
W. ADAMS.
AND
ABSTRACTS
“77
All operated eases were followed up aa to the effect on this particular syrr~ptom. Replies were received from 152 patients, of which 62 had had no backache since the operation. Forty-two were much improved and 41 were no better. Seventy-three per cent of backaches associated with a gynecologic abnormality were cured or much relieved by appropriate surgical treatment. The importance of backache in uncomplicated retroversion and retroflexion haa been much exaggerated, as it is found, almost as frequently, in cases where the uterus is in a forward position. The most important factor in produring backache is fatigue of muscles. Where there is a definite indication for surgical treatment the backache can be cured or much relieved in over seventy per cent of CRSI~S,the rpnu1t.s being especialI! good in cases of prolapse treated by colporrhaph~. NORMAN F. Mrra,c~. Huet: Rupture and Perforation of Pgosalpinx into the Peritoneal Cavity. Journal de ,Chirurgie, 1924, xxiii, 123. The frequency of ruptured pyosalpinx, as given by various authors, differs widely, but it, certainly cannot be classed as a rare occurrence. Rupture may be caused by direct trauma of some kind or may be due to the lighting up of an old infection. In the first type, there is found a distinct tear in the tubal wall, while in the second, the aperture is more of the nature of a perforation, being due to the formation of perforatire ulcers. In ten cases of rupture due to trauma there were only three deaths but in twelve perforations eight deaths. These perforations vary greatly in size and shape and often are surrounded by a necrotic zone. They are usually single but in one Case two openings were found. The rupture occurs most. frequently in the ampulla of the tube. The principal symptoms are severe pain, collapse, pallor, chills, and aeeeleratiou of pulse, followed by a steady rise in temperature, nausea and vomiting. The onset follows immediately the trauma in the cases of true rupture while in the cases of perforation the characteristic symptoms may not be present for several days. There is a marked rigidity of the abdomen with abdominal tenderness and lack of motion on respiration. Rupture of the bladder, ruptured appcndir and ruptured tubal pregnancy must be considered in the differential diagnosis. Where the diaguosis is made early, operatiuu is clearly indicated. If, however. the condition has progressed to the stage of abdominal dis:elltion, the prognosis is extremely poor. When the collection of pus is more or less loralized and low down in the pelvis a posterior colpotomy is the operation of choice. This, ho\\ever, implies the danger of leaving the infected tube as possible source of reinfection. Therefore, in those eases where laparotomy is necessary to reach the pus, he advocat?s a rcmoval of the tube. Following all such laparotomies he inserts a drain at the low\:c?l end of the incision down into the culdesac. THEODORE W. ADAMS. 111% Tixier and Rochet: Salpingitis in Elderly Women. Archives France-Belgcs Chirurgie, 1925, xxviii, 659. In patients from thirty-five to forty-five years of age salpingitis assumes an extremely grave aspect. It occurs unexpectedly both in women who have previously had,a genital infecticn, and in those in whom there is no tracae of previous infections pathology. In the latter type there often exists a source of latent infection such a?? In elderly women salpingitis is a degenerating fibroid or small local infections. cured but seldom by medical treatment and the prognosis is always poor even SO far as life is concerned. The treatment of choice is total hysterectomy as at this time of life the symptoms of postoperative menopause arc negligible. THEODORE
W. ADAMS.