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Three cases of persistent ano-genital pruritus treated surgically
1034
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GT?iECOLOGV
11. Negro, married, aged thirty-six, para iii, gravida iv. Gestation, three and onehalf months. Self-induced. Died forty-fifth day. Autopsy: pelvic abscess ; thrombophlebitis, right leg. 12. white, married, aged thirty-four, para 9, gravida 1. Gestation, three months. Denied induction. Died in nineteen hours. Autopsy: septicemia; hemolytir: jaundice; thrombophlebitis left ovarian veins. (Omitted in corrected mortality.)
In an effort to correct a source of error that might be found in the fact that some of the patients admitted with high temperatures were considered too sick to subject to any operative procedure and would thus fall in the conservatively treated group, all cases in Chart 3 admitted with a temperature of lOlo, or higher, were listed separately and are summarized in Chart 4. In Group A every patient had a temperature of at least lOlo, with several as high as 106”, at the time the uterus was emptied with the ovum forceps. Not one complication that could in any way be blamed on the procedure occurred in this group. Again it will be noted that the value of “P” is less than one in both instances. The deaths are detailed under the discussion of Chart 3. In Group A, Nos. 4 and 5 ; in Group U. Nos. 1, 3, 4, 6! 7> 8. 9. and II. CONCLUSIONS
1. There were 92.3 per cent of the patients in this series married and 80.5 per cent had had an average of 2.6 full-term deliveries, apparently indicating the need of wider contraceptive education. 2. Results of treatment of all cases compare favorably as to morbidity and mortality with other recently reported series. 3. Best results were obtained in that group of cases where secundines were removed and drainage established by the method described.
Cotte, G., and Gat6, J.: Three Cases of Persistent Ano-Genital Pruritus Surgically, GynCcologie 34: 644, 1035.
Treated
The authors report three cases of stubborn anogenital pruritus which they They believe that in eldery women a vulrectomy should be treated surgically. performed, combined with removal of the clitoris and resection of the internal pudic nerves. However, in women who have an active sexual life and in those where the pruritus extends beyond the vulva and involves the anus, the buttocks ant1 the perineum and also in men, resection of the internal pudic nerves may not only not suffice but may result in disturbances in the sexual function. For these cases the authors recommend resection of the pelvic sympathetic plexus and also of the peri-iliac hypogastric sympathetics. If dnring the laparotomy any abnormalities arc found in the uterus or adnexa, these should be treated because there is no donbt, that certain cases of pruritus have their origin in reflex hypogastric plexalgia which is due to intrapelvic disturbances or in a plexitis secondary to a pelvic cellulitis. J. P. GREENHILL.
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GT?iECOLOGV
11. Negro, married, aged thirty-six, para iii, gravida iv. Gestation, three and onehalf months. Self-induced. Died forty-fifth day. Autopsy: pelvic abscess ; thrombophlebitis, right leg. 12. white, married, aged thirty-four, para 9, gravida 1. Gestation, three months. Denied induction. Died in nineteen hours. Autopsy: septicemia; hemolytir: jaundice; thrombophlebitis left ovarian veins. (Omitted in corrected mortality.)
In an effort to correct a source of error that might be found in the fact that some of the patients admitted with high temperatures were considered too sick to subject to any operative procedure and would thus fall in the conservatively treated group, all cases in Chart 3 admitted with a temperature of lOlo, or higher, were listed separately and are summarized in Chart 4. In Group A every patient had a temperature of at least lOlo, with several as high as 106”, at the time the uterus was emptied with the ovum forceps. Not one complication that could in any way be blamed on the procedure occurred in this group. Again it will be noted that the value of “P” is less than one in both instances. The deaths are detailed under the discussion of Chart 3. In Group A, Nos. 4 and 5 ; in Group U. Nos. 1, 3, 4, 6! 7> 8. 9. and II. CONCLUSIONS
1. There were 92.3 per cent of the patients in this series married and 80.5 per cent had had an average of 2.6 full-term deliveries, apparently indicating the need of wider contraceptive education. 2. Results of treatment of all cases compare favorably as to morbidity and mortality with other recently reported series. 3. Best results were obtained in that group of cases where secundines were removed and drainage established by the method described.
Cotte, G., and Gat6, J.: Three Cases of Persistent Ano-Genital Pruritus Surgically, GynCcologie 34: 644, 1035.
Treated
The authors report three cases of stubborn anogenital pruritus which they They believe that in eldery women a vulrectomy should be treated surgically. performed, combined with removal of the clitoris and resection of the internal pudic nerves. However, in women who have an active sexual life and in those where the pruritus extends beyond the vulva and involves the anus, the buttocks ant1 the perineum and also in men, resection of the internal pudic nerves may not only not suffice but may result in disturbances in the sexual function. For these cases the authors recommend resection of the pelvic sympathetic plexus and also of the peri-iliac hypogastric sympathetics. If dnring the laparotomy any abnormalities arc found in the uterus or adnexa, these should be treated because there is no donbt, that certain cases of pruritus have their origin in reflex hypogastric plexalgia which is due to intrapelvic disturbances or in a plexitis secondary to a pelvic cellulitis. J. P. GREENHILL.