Edward H. Copenhaver

A critical assessment of culdoscopy.

Results of 106 culdoscopies performed at the Lahey Clinic from July 1 1959 to July 1 1969 are analyzed. 12 operative failures have been excluded. The main indications for culdoscopy should be limited. Differential diagnosis of acute pelvic problems and infertility are 2 acceptable indicators. Investigation of chronic pelvic pain has been disappointing. Culdoscopy is unnecessary in many instances of amenorrhea and for pelvic pain. Most of these cases proved psychogenic in origin. 38 amenorrheic patients were studied. 16 patients underwent culdoscopy for infertility. It is suggested that for normal infertile c ouples a 12-month observation period precede culdoscopy. Culdoscopy for pelvic mass is only indicated for subserous uterine leiomyoma and ovarian hematoma of a functional cyst that is to be differentiated from an ectopic pregnancy.

Management of stage I adenocarcinoma of the endometrium

Abstract Preoperative staging indicated confinement of the tumor to the uterus in 203 of 246 patients with endometrial adenocarcinoma; the accuracy of staging was 91 per cent. The absolute 5 year rate of cure was 76 per cent. Considerable uterine enlargement and undifferentiated tumor significantly reduced this rate. Although growing evidence indicates a reduction in vaginal recurrences with irradiation, its necessity in achieving this goal and its role in prolonging survival are questioned. Our current management includes restricting surgical manipulation to a minimum; resorting to operation alone for the early, well-differentiated lesion, blocking the cervical canal effectively; and subjecting the total pelvis to preoperative irradiation when the lesion is more advanced or undifferentiated.

Vaginal Hysterectomy: Past, Present, and Future

Progress has been made in the following aspects of vaginal hysterectomy: improvement of technique and reduction of the incidence of febrile morbidity, the length of hospitalization, and the postoperative retention of urine with associated repair. Vaginal hysterectomy should continue to have its widest application in women whose childbearing is complete and who have incapacitating hypermenorrhea and dysmenorrhea with or without small uterine leiomyomas or adenomyosis.

Obstacles in the Control of Cancer of the Cervix

Lethargy on the part of women and their physicians may be a greater obstacle in the control of cervical cancer than technologic shortcomings or inadequate laboratory facilities for cytology. Of 500 new gynecologic patients surveyed at the Lahey Clinic, 37 per cent had never had a vaginal smear and 41 per cent had not had a vaginal smear in five years. No valid reason was elicited, but cost was a minor factor. Physicians have been too selective in application of the vaginal smear; only 19 per cent always obtain a vaginal smear.