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Tubal Pregnancy at Term
600
AMERICAN JOURNAL OF OBSTE'l'RlCS Al\D GY.'-JE(!OLOGY
tion showed an adjustment to the loss of the spleen, as there were 4,::JOO,OOO red eells, a hemoglobin of 85 per cent, 9,400 white cells, fi,'j per cent polynuelears, :H per cent lymphocytes, and 1 per cent transitionals. Wandering spleen has been reported many times, the organ having been found in all parts of the abdomen, especially in tlw lf'ft lower portion, rarely as the contents of umbilical, ventral, and diaphragmatic herniae. Almost invariably when in or near tht> pelvis it has been confused with a twisted pedicle ovarian <7st. In my case it seems reasonable to assume that the chief causative factors were the asthenia and emaciation, and the pronounced forward bowing of the spine in the upper lumbar region. 40
EAST SIXTY-FIRST STREET.
'l'UBAL PREGNANCY AT TERM B. B.
WECHSIJER,
M.D.,
NEW YORK, N.Y.
ATIENT, N. H., colored, aged thirty-six, married twenty-one years, first seen by me, January 27, 1928, with a complaint of generalized abdominal pain of sudden onset. Last menstruated April, 1927. She had slight morning nausea at first, but no vomiting. There were occasional headaches, but no vertigo. There had been some urinary frequency. Quickening was first noted in August, 1927, and e,ontinued until onset of abdominal pain. According to this history the expected elate of confinement would he about January, 1928. There had never bePn any menstrual disturbances since onset at age of fourteen. No urinary disturbance, nor vaginal discharge at any time. She married at the age of fifteen, and the following year was delivered of a nine pound living child. The delivery was spontaneous, and the puerperium normal. She did not conceive again until 1926. At this time a diagnosis was made in about the sixth week of a left tubal pregnancy, aa
P
NEUS'l'AED'l'ER :
LEUCOKRAURO~I~
601
The patient had a comparatively uneventful recovery. The temperature remained elevated to 100° F: for about two weeks. She was dischargPd from the hospital on April 4 fully recovered.
REPORT OF A CASE OF LEUCOKRAUROSIS (KRAUROSIS VUINAE) CURED BY VULVECTOMY* THEODORE NEUSTAEDTER,
M.D., L.M.
(DUBLIN)' NEW YORK, N.Y.
(F1·om the Gynecological Service of the Central N enrological Hospital, Welfare Island, N. Y.) HILE leucokranrosis is not uncommon in gynecologic practice, complete una· nimity as to nomenclature and pathology does not exist. Graws and Smith' have suggested the term leucokraurosis and have clearly shown that kraurosis vulvae is not a disease entity, but a late stage of leucoplakia of the vuh·a. Szasz (cited by Gran•s and Smith) differentiates the pathology of the two stages. The etiology is still a moot question. This case report is of interest because it further stresses the value of surgical treat· ment for its cure, since all other measures have been proved to be palliative only.
W
CASE REPOR'l'
Mrs. M. D., Spanish, aged sixty-nine, widow, no children, was admitted to the gyne· cological service August 16, 1931. She complained of intense itching of the external genitalia, pain, and burning on micturition. The family history is irrelevant. Menstrual periods normal, menopause at forty~seven. One pregnancy which aborted at three months. Pneumonia at nine, and typhQid at ten years of age. Cataract operation on both eyes eight years ago. Five years ago she was operated upon for a uterine tumor, myomectomy. At that time she suffered from vaginal bleeding, which terminated three weeks after the opera· tion, abdominal pain, tenesmus, and dysuria. Some months later itching of the external gen11alnt :::JeL 111. rrhe pruritus was not constant; there \vould be intervals of several weeks when she was t•ompletely free from this annoyance. As time went on, the inter· vals grew shorter and insomnia set in. She also developed a thick yellowish discharge. This symptom complex grew steadily worse. About one year ago she was treated with topical applications and then x-ray thf'rapy which met with temporary success only. For the past year there has been pain around the introitus. At the present time her itching is very severe and continuous, she cannot refrain from scratching the vulva, and urinary frequency, nocturia, dysuria, and tenesmus are present. Appetite fair, no digestive disturbances, but is constipated. The patient appeared to be in good physical condition. Blood pressure 180/100. Bimanual examination was impossible due to contracture of the introitus. The external genitals were painful to the touch. The labia majora were atrophic and labia minora were absent. On the labia and on their inner surfaces, extending from the clitoris to the posterior commissure, were hard, white, dry, slightly raised, parchment· like excreseences. Superimposed were two small elevations the size of ten-cent pieees, also somewhat hard. Rectal examination did not reyeal any pelvic pathology. A preoperative diagnosis of leucokraurosis (kraurosis vulvae) was made. On August 28, 1931, under ether anesthesia a \·ulvectomy was performed. The incision was carried from above the clitoris downward and backward on each side to the fourchet including both labia majora and describing a complete oval about the entire vulva, separating the healthy from the diseased tissue. A second incision was made around the vaginal orifice being carried up anteriorly across the vestibule so as not to encroach too closely *Presented before the Section of Obstetries and Gynecology, N. Y. Academy nf Medicine, Aprii 26, 1932.
AMERICAN JOURNAL OF OBSTE'l'RlCS Al\D GY.'-JE(!OLOGY
tion showed an adjustment to the loss of the spleen, as there were 4,::JOO,OOO red eells, a hemoglobin of 85 per cent, 9,400 white cells, fi,'j per cent polynuelears, :H per cent lymphocytes, and 1 per cent transitionals. Wandering spleen has been reported many times, the organ having been found in all parts of the abdomen, especially in tlw lf'ft lower portion, rarely as the contents of umbilical, ventral, and diaphragmatic herniae. Almost invariably when in or near tht> pelvis it has been confused with a twisted pedicle ovarian <7st. In my case it seems reasonable to assume that the chief causative factors were the asthenia and emaciation, and the pronounced forward bowing of the spine in the upper lumbar region. 40
EAST SIXTY-FIRST STREET.
'l'UBAL PREGNANCY AT TERM B. B.
WECHSIJER,
M.D.,
NEW YORK, N.Y.
ATIENT, N. H., colored, aged thirty-six, married twenty-one years, first seen by me, January 27, 1928, with a complaint of generalized abdominal pain of sudden onset. Last menstruated April, 1927. She had slight morning nausea at first, but no vomiting. There were occasional headaches, but no vertigo. There had been some urinary frequency. Quickening was first noted in August, 1927, and e,ontinued until onset of abdominal pain. According to this history the expected elate of confinement would he about January, 1928. There had never bePn any menstrual disturbances since onset at age of fourteen. No urinary disturbance, nor vaginal discharge at any time. She married at the age of fifteen, and the following year was delivered of a nine pound living child. The delivery was spontaneous, and the puerperium normal. She did not conceive again until 1926. At this time a diagnosis was made in about the sixth week of a left tubal pregnancy, aa
P
NEUS'l'AED'l'ER :
LEUCOKRAURO~I~
601
The patient had a comparatively uneventful recovery. The temperature remained elevated to 100° F: for about two weeks. She was dischargPd from the hospital on April 4 fully recovered.
REPORT OF A CASE OF LEUCOKRAUROSIS (KRAUROSIS VUINAE) CURED BY VULVECTOMY* THEODORE NEUSTAEDTER,
M.D., L.M.
(DUBLIN)' NEW YORK, N.Y.
(F1·om the Gynecological Service of the Central N enrological Hospital, Welfare Island, N. Y.) HILE leucokranrosis is not uncommon in gynecologic practice, complete una· nimity as to nomenclature and pathology does not exist. Graws and Smith' have suggested the term leucokraurosis and have clearly shown that kraurosis vulvae is not a disease entity, but a late stage of leucoplakia of the vuh·a. Szasz (cited by Gran•s and Smith) differentiates the pathology of the two stages. The etiology is still a moot question. This case report is of interest because it further stresses the value of surgical treat· ment for its cure, since all other measures have been proved to be palliative only.
W
CASE REPOR'l'
Mrs. M. D., Spanish, aged sixty-nine, widow, no children, was admitted to the gyne· cological service August 16, 1931. She complained of intense itching of the external genitalia, pain, and burning on micturition. The family history is irrelevant. Menstrual periods normal, menopause at forty~seven. One pregnancy which aborted at three months. Pneumonia at nine, and typhQid at ten years of age. Cataract operation on both eyes eight years ago. Five years ago she was operated upon for a uterine tumor, myomectomy. At that time she suffered from vaginal bleeding, which terminated three weeks after the opera· tion, abdominal pain, tenesmus, and dysuria. Some months later itching of the external gen11alnt :::JeL 111. rrhe pruritus was not constant; there \vould be intervals of several weeks when she was t•ompletely free from this annoyance. As time went on, the inter· vals grew shorter and insomnia set in. She also developed a thick yellowish discharge. This symptom complex grew steadily worse. About one year ago she was treated with topical applications and then x-ray thf'rapy which met with temporary success only. For the past year there has been pain around the introitus. At the present time her itching is very severe and continuous, she cannot refrain from scratching the vulva, and urinary frequency, nocturia, dysuria, and tenesmus are present. Appetite fair, no digestive disturbances, but is constipated. The patient appeared to be in good physical condition. Blood pressure 180/100. Bimanual examination was impossible due to contracture of the introitus. The external genitals were painful to the touch. The labia majora were atrophic and labia minora were absent. On the labia and on their inner surfaces, extending from the clitoris to the posterior commissure, were hard, white, dry, slightly raised, parchment· like excreseences. Superimposed were two small elevations the size of ten-cent pieees, also somewhat hard. Rectal examination did not reyeal any pelvic pathology. A preoperative diagnosis of leucokraurosis (kraurosis vulvae) was made. On August 28, 1931, under ether anesthesia a \·ulvectomy was performed. The incision was carried from above the clitoris downward and backward on each side to the fourchet including both labia majora and describing a complete oval about the entire vulva, separating the healthy from the diseased tissue. A second incision was made around the vaginal orifice being carried up anteriorly across the vestibule so as not to encroach too closely *Presented before the Section of Obstetries and Gynecology, N. Y. Academy nf Medicine, Aprii 26, 1932.