Vol 7, No 2 (1893)

The doctrine of the twisting of the pedicle of the tumors of the uterine appendages (ovaries, steamer, wide ligaments, tubes) seems far from complete. By the way, a very interesting question about the cause of the twisting remains open to this day [1]. This question, as is known, was solved very differently

Married, 40 years old, mother of 8 children, of which the youngest is 5 years old. All labor is urgent and normal. Two years ago, she covered up a mobile tumor in the right half of the abdomen, which caused pulling pains and irregularities in the intestines. When examined on January 13, this tumor was recognized as a right mobile kidney; but on the left side of the retroverted uterus, another very sensitive tumor was palpated from a pigeon's egg, which was mistaken by the author for the left hyperemic displaced ovary.

The author, based mainly on the report of the Paris Academy of Travel to Italy, specially for the study of the symphysisotomy of Charpentier a ["De la symphiséotomie." Extrait du Bulletin de 1 Académie de Medicine (séances du 15 et 22 Mars 1892, 36 pp.)] Gives a very detailed literary-historical overview of the methods of production, the demonstration, meaning and future of this operation, resurrected thanks to the Napolitan obstetricians, now more and more attention is paid to the medical world. Hippocrates also pointed out that “the pubic bones at the end of pregnancy diverge to the right and left sides” (Hippokrates, Denatura pueri). Riolanus (Manuel anatom., P. 626) and Ambroise Paré (Oeuvres, Livre 24, Chap. 13), as well as Galenus, even mention that in antiquity even young girls were ripped open in order to facilitate childbirth in the future ... The terrible mortality from Caesar's misconceptions from the old days led obstetricians to think about symphysisotomy. According to Krassovsky (Operative obstetrician, 3rd edition 1885, p. 624), he first performed a symphysiotomy on a corpse after the death of a woman in labor, Dr. Jean Claude de la Couvre in Warsaw in 1585. Winckel, however, points to 1654, and Charpentier to 1655.

Mrs. N., 33 years old, multipara; 13 Feb urgent labor; as the last was tightly fastened, the uneducated midwife began to pull the umbilical cord, all through which there was an inversion, which passed unnoticed at first. But. when on the next day the woman in labor, who had not urinated for a whole day, got up for this purpose from the bed, a prolapse of the uterus occurred. The author, invited Feb 15 found the uterus protruding from the genital gap by 6-8 inches, partial vaginal inversion, easy bleeding, frequent pulse, severe abdominal pain.

Looking through the literature of the last few years, we come across an increasing number of cases where, when examined remotely, by means of womb or through the vagina, the uterus found the coexistence of fibroids and cancer or sarcoma, and only one tumor was diagnosed before surgery; in general, according to the statistical data of the last years, the simultaneous defeat of the uterus with a benign and malignant tumor is relatively far from being as rare as it might seem (A. Martin, for example, on 205 extirpation of the uterus in 9 cases, found cancer at the same time). In view of the extreme importance of timely and correct diagnosis of such cases, the author describes in detail 4 of them, introduced into his practice, and on the basis of them comes to the following conclusions.

The research I started under the guidance of Professor K. F. Slavyansky was published in 1891 under the title: “Concerning the accumulation of fluid in the fallopian tube”) and “Experimentelle Untersuchungen über die Pio und Hydrosalpinxbildung bei den Thieren”). In these works it is indicated that, contrary to the opinion of prof. Kehrer'a and then Landau, there is a cystic accumulation of fluid in the fallopian tube of a rabbit with a simple ligation of it with a silk thread.

Patient girl, 25 years old. For the first time, she covered up a small tumor in her left groin in the summer of 1888. The appearance of this tumor was accompanied by frequent urge to urinate and the inability to empty the bladder. The horizontal position and pressure on the tumor made not only the tumor disappear, but also the concomitant phenomena from the bladder. The size of the tumor was equal to the bean.

Both cases reported by the author have the following clinical and surgical interest: in both - the tumor was not large and so tightly connected to the uterus that the uterus and tumor moved together; this made one suspect the existence of a uterine fibroid. On the other hand, the age (30 and 24 years) of the patients and the relatively rapid growth of the tumor spoke in favor of ovarian disease, although, again, fibroids can appear in young women and grow quickly, moreover, the indication of the patients themselves regarding tumor growth is usually very erroneous and they deserve full confidence. Under such conditions, exploratory charevoschene was not only justified, but also directly demonstrated. The result of the operation really showed that the further waiting would only increase the danger of the later operation. An ovarian tumor cannot be removed early enough, and this rule is made even more mandatory for the surgeon when the bimanual examination and probe indicate a tight connection of the tumor with the uterus. Removal of a large ovarian tumor with a very short stem or without a stem is an extremely serious operation.

Ms X., 43 y., Multipara, always in good health, told Dr Jacobs: six months ago she felt pains in the ovarian region, which intensified with the passage of time; the stomach gradually increased in volume. Other painful symptoms appeared: sleeplessness, lack of appetite, obstructed defecation, and urination. External examination: the abdomen is significantly increased in volume and a tumor is felt in the lower part; accumulation of fluid in the abdominal cavity.

The disease begins with headaches lasting 2 days, then colicky pains in the abdomen come to the fore, with painful sensations on palpation in the Colon descendens area. Opіy only slightly and for a short time reduces pain and as a result of this rinsing of the intestines is impossible. Acceptance 01. Ricini induces vomiting. Warm poultices relieve colicky pain only when they are applied. As soon as it cools, the pain intensifies. This Status continues from September 7 to September 15, when a clearly flattened defecation appeared. Intestinal stenosis is diagnosed. Despite the use of narcotic drugs, colicky pains are so excruciating that the child rushes about in bed and screams good obscenities. The new study shows increased sensitivity in the left groin area, in the right groin area the pain is much less. Due to this edge of intestinal stenosis, an inflammatory process of the peritoneum of this space is assumed. Examination under anesthesia showed: an abscess in the left posterior fornix, which protrudes more posteriorly and presses the anterior wall of the recti into the intestinal lumen. Trial puncture into the posterior fornix. A large amount of green pus is erupting. The trocar tube is left in the abscess opening. Warm baths and warm flaxseed poultices are prescribed. Colicky pain after puncture is significantly reduced; appetite appeared. On September 20, pains again come as a result of stagnation of expiration. September 23 secondary punctuation. Significant relief of all symptoms. In the next days, the puncture site again overgrown and the pains resumed, but on September 27. during defecation, a mass of pus came out. Since then, the patient began to slowly recover. On October 15, pus came out of the last cut. The next day the temperature dropped to 36.5 °. In 3 months after the onset of the disease, the patient began to attend school.