Curtis H. Tyrone

A survey of a series of myomectomies, with a follow-up☆

Abstract 1. 1. Myomectomy is a safe and conservative treatment for fibroids, as represented by a mortality of 0.77 per cent in 128 cases. 2. 2. This procedure offers almost complete relief from dysmenorrhea and menorrhagia which result from the presence of fibroids. 3. 3. The reasonable expectancy of pregnancy in young women under thirty-eight years of age, following myomectomy, according to our series is 33⅓ per cent. 4. 4. The percentage of recurrence of fibroids after myomectomy was 3.08 per cent in our experience. 5. 5. Myomectomy during pregnancy is only indicated where definite necrobiotic processes are present. 6. 6. In the series analyzed, acute obstruction of the bowel occurred in 1.5 per cent of the patients during the hospital stay; 0.75 per cent acute obstruction occurred subsequently as a complication of pregnancy, and 0.75 per cent chronic partial obstruction.

Total hysterectomy at cesarean section and in the immediate puerperal period.

Abstract 1. 1. Eighty-five total hysterectomies at cesarean section or post delivery are herewith presented. Ten are from private practice, and 75 are from the Tulane Obstetrical Services. 2. 2. Although the total number were collected within a three and one-half year period, they represent a small percentage of the total number of cesarean sections performed (150 per year). The present section rate is 3.72 per cent (Tulane). 3. 3. Approximately 44 per cent of the sections are repeat sections and 23 per cent are for disproportion. These added to the relative high incidence of toxemia, fibroids, and abruptio placentae in the Negroes (80 per cent of total deliveries) will eventually produce many women in whom hysterectomy is indicated. 4. 4. The indications for total hysterectomy at cesarean section or in the immediate puerperium are the same as for the subtotal or Porro section. 5. 5. The uterus is amputated above the cervix and the technique for removal of the cervix is described. 6. 6. There were no surgical complications in 73 patients. Seven exhibited shock, 2 hemorrhage, 2 afibrinogenemia, and 1 spinal shock. 7. 7. Postoperative complications were observed in 30 cases consisting of atelectasis (mild), mild ileus, urinary tract infection, and shock. There were two pelvic hematomas of minor degree, 1 cuff hemorrhage, 3 instances of anuria, and 1 of abdominal wound separation. 8. 8. Thirty patients were morbid for 1 or more days (35.3 per cent) and 7 for 3 or more days (8.2 per cent). 9. 9. There were 19 stillbirths, 7 of which occurred in ruptured uteri, 10 from abruptio, 1 from erythroblastosis, and 1 from neglected transverse lie, a rate of 22.3 per cent. 10. 10. Two maternal deaths (2.35 per cent) were incidental to the procedure. One of these mothers had long-standing pertionitis associated with uterine rupture, and the other, with eclampsia, abruptio, Couvelaire uterus, and lower nephron nephrosis, died on the twentieth postoperative day of a cerebral thrombosis. 11. 11. Operative experience has shown that there is no cause to leave the cervix in situ for fear of increased bleeding or operative time. Postpartum vaginal support has been universally sound.

Vaginal hysterectomy: Analysis of 305 consecutive cases

Abstract A detailed analysis of 305 consecutive cases of vaginal hysterectomy with a mortality rate of 0.65 per cent is presented.

The management of the retained cervical stump

Abstract 1. 1. The importance of recognizing pathologic conditions of the cervical stump is emphasized. 2. 2. The performance of complete hysterectomy in all indicated cases is urged. 3. 3. The treatment of chronic diseases of the cervical stump is discussed and the technic of removal of the stump is described. 4. 4. Forty-four cases of chronic cervicitis of the stump are briefly analyzed.