James C. Masson

Bilateral Petit's hernia and an anterior sacral meningocele occurring in the same patient

Abstract We have reported data on a case in which there were two unusual lesions of congenital origin, bilateral Petits hernia and anterior sacral meningocele, both of which proved amenable to surgical treatment. Although anterior sacral meningoceles are rare, they must be considered when dealing with retroperitoneal pelvic masses. These lesions are of particular importance to the surgeon, since he is faced with the possibility of fatal meningitis unless he recognizes the lesion and repairs it at the time of operation. Closure of the defect in the continuity of the spinal canal in this case was accomplished by use of oxidized gauze packs impregnated with thrombin. A large, incapacitating Petit hernia was repaired by a basket-weave method, using strips of fascia lata with anchorage to the iliac crest and transverse processes of the lumbar vertebrae. Although a Petit hernia is unusual, the case reported is even more so, since the hernias were congenital and bilateral.

Congenital absence of the vagina and its treatment

Abstract Congenital absence of the vagina is a rare condition, but is common enough to warrant serious consideration. Handling of cases from the psychologic standpoint is important, and operation should never be urged. Operation should not be advised until marriage is contemplated unless hematometra develops as the result of retained menses in a more or less normal uterus. If patients insist, operative correction is justifiable at any time. Two types of operation, the use of skin flaps or sections of the bowel may be employed. I believe that a section of small bowel used as advised by Baldwin gives the best functional results, and although a more dangerous operation, it is relatively safe when properly done. It is, moreover, justifiable. A dilator should be used until healing is satisfactory.

Fistula of the uterus

Abstract Fistula of the uterus is relatively infrequent as a postoperative complication. The diagnosis can be made almost entirely from the existence of a postoperative abdominal fistula which periodically discharges blood-tinged fluid coincident with menstruation. Operations in the presence of acute pelvic inflammation, abscess or tuberculosis, especially when they involve the incomplete removal of the inflammatory tissue, and the use of nonabsorbable suture material, are the outstanding causes of the formation of fistula of the uterus. Radical surgical removal of the fistulous tract, inflammatory tissue, and foreign bodies, when present, is usually indicated. This procedure is attended by a low mortality rate and good results.

The use of zinc chloride in gynecology

Abstract The zinc chloride treatment is simple, but should be undertaken with scrupulous care. There must be no excess of solution on the gauze, for uterine contractions may squeeze a few drops of zinc chloride through the tubes into the pelvic peritoneum or through the cervix into the vagina. The gauze must not touch any part of the genitalia before it enters the uterus or a burn will result. This operation occupies a position intermediate between a simple curettage on the one hand and a surgical hysterectomy on the other. Its field of usefulness is probably very limited and the indications for its use are not many, but in a few carefully selected cases, it may be very valuable. The patients should be those who are passing through, or have passed the menopause, and are having abnormal bleeding or leucorrhea, not due to malignancy, for whom a hysterectomy hardly seems justified, and less radical methods would not give good results. The chief disadvantage is the lack of any very accurate means of dosage. The complications which have been described by other authors are excessive erosion and sloughing; hemorrhage, sometimes alarming; stenosis of the cervix with hydrometra, requiring surgical intervention; pelvic and generalized peritonitis, sometimes ending fatally, and death due to toxic absorption. Most of these, however, occurred when the solution was injected directly into the uterus by means of a syringe, or when little was done to protect the vagina. The advantages of the procedure are its simplicity and the fact that the endometrium can be destroyed without injury to the ovaries. A major operation can be avoided in certain borderline cases. Should this treatment prove unsatisfactory, hysterectomy can still be performed.

Surgical treatment of dysmenorrhea

Abstract Surgical intervention for the alleviation of dysmenorrhea produced complete relief in 29 cases and was of benefit in an additional 43 cases. In 14 cases in which hysterectomy was performed the patients still complain of some pain which can be attributed to a tender ovary in some of the cases. In 22 cases there was no relief of the dysmenorrhea. The only procedure which produced uniformly poor results was the insertion of the Baldwin tube, but this procedure has subsequently been discarded.