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The danger of infection from catheterization of the bladder and indications for catheterization in obstetric cases
478
AMHRJCAX
JO-URNAL
OF
OBSTETRICS
AND
GYNECOLOGY
Again, common sites of metastasis are the vagina and. vulva, the mechanism of which has not been satisfactorily explained, although von Recklinghausen attempted it in his theory of retrograde lymphatic transmission. These vaginal metastases are peculiar in that they may not make their appearance for months, although sometimes they are noted even before the primary uterine growth has been discovered. Under such conditions, panhysterectomy will be of no avail. Tumors composed of fetal cells are markedly under the influence of the gonadal hormones, or, rather, seem to exert a profound effect upon the activity and production of these substances. Hence, it would seem advisable to preserve the regularly recurring cycle of estrin and progestin formation in the hope that by this means, retrogression and absorption of the aberrant fetal elements might be facilitated. Allowing the ovaries to remain, therefore, is worthy of trial. Study of the present series of cases has convinced the writers that. much more information may be obtained concerning chorionepithelioma ; first, by the systematic histologic examination of hydatidiform moles to ascertain whether or not the piling up of decidual cells in portions of certain of these growths taken in conjunction with the subsequent history of the patient is indicative of potential malignancy; and second, by the intensive study of reasonably large groups of cases which may be accom$ished by the pooling of material in the larger cities, and its working up by individuals or committees appointed by local obstetric or gynecologic societies. Smuc~ EWREET 1521 LINICEY AVENUE
1814
Settergren, P.: The Danger of Infection and Indications for Catheterization in Bcandinav. 16: 20“ “7 1936 .
Prom Catheterization Obstetric Cases, Acta
of the Bladder obst. et gym%.
The material comprises 400 cases evenly divided into two groups. In Group 1, each patient was catheterized at least three times before she was discharged from the hospital. No antiseptics were used before the catheter was inserted into the bladder. In Group 2, on the other hand, catheterization was performed only upon definite indications and always under antiseptic precautions. Infections occurred in 29.2 per cent of the first group, and in only 12.2 per cent of the second group. If the presence of pus cells js used as a criterion of infection, the corresponding figures are 20.5 per cent for Group 1, and 5 per cent for Group 2. The author feels certain that the number of urinary infections increased with the number of catheterizations. Only a small number of patients developed subjective symptoms and pyelitis occurred in only one case. Follow-up examinations from two to four weeks after delivery showed spontaneous healing in most instances. The author is of the opinion that urinary antiseptics should be given prophylactically to most women immediately after labor. The author suggests a new way of obtaining sterile specimens of urine after delivery. J. P. GREENHILL.
AMHRJCAX
JO-URNAL
OF
OBSTETRICS
AND
GYNECOLOGY
Again, common sites of metastasis are the vagina and. vulva, the mechanism of which has not been satisfactorily explained, although von Recklinghausen attempted it in his theory of retrograde lymphatic transmission. These vaginal metastases are peculiar in that they may not make their appearance for months, although sometimes they are noted even before the primary uterine growth has been discovered. Under such conditions, panhysterectomy will be of no avail. Tumors composed of fetal cells are markedly under the influence of the gonadal hormones, or, rather, seem to exert a profound effect upon the activity and production of these substances. Hence, it would seem advisable to preserve the regularly recurring cycle of estrin and progestin formation in the hope that by this means, retrogression and absorption of the aberrant fetal elements might be facilitated. Allowing the ovaries to remain, therefore, is worthy of trial. Study of the present series of cases has convinced the writers that. much more information may be obtained concerning chorionepithelioma ; first, by the systematic histologic examination of hydatidiform moles to ascertain whether or not the piling up of decidual cells in portions of certain of these growths taken in conjunction with the subsequent history of the patient is indicative of potential malignancy; and second, by the intensive study of reasonably large groups of cases which may be accom$ished by the pooling of material in the larger cities, and its working up by individuals or committees appointed by local obstetric or gynecologic societies. Smuc~ EWREET 1521 LINICEY AVENUE
1814
Settergren, P.: The Danger of Infection and Indications for Catheterization in Bcandinav. 16: 20“ “7 1936 .
Prom Catheterization Obstetric Cases, Acta
of the Bladder obst. et gym%.
The material comprises 400 cases evenly divided into two groups. In Group 1, each patient was catheterized at least three times before she was discharged from the hospital. No antiseptics were used before the catheter was inserted into the bladder. In Group 2, on the other hand, catheterization was performed only upon definite indications and always under antiseptic precautions. Infections occurred in 29.2 per cent of the first group, and in only 12.2 per cent of the second group. If the presence of pus cells js used as a criterion of infection, the corresponding figures are 20.5 per cent for Group 1, and 5 per cent for Group 2. The author feels certain that the number of urinary infections increased with the number of catheterizations. Only a small number of patients developed subjective symptoms and pyelitis occurred in only one case. Follow-up examinations from two to four weeks after delivery showed spontaneous healing in most instances. The author is of the opinion that urinary antiseptics should be given prophylactically to most women immediately after labor. The author suggests a new way of obtaining sterile specimens of urine after delivery. J. P. GREENHILL.