Joe V. Meigs

Fibroma of the Ovary with Ascites and Hydrothorax

Summary There have been described in this paper seven cases of ascites and hydrothorax due to the presence of a tumor of the ovary of a nonsecretory type. The importance of such a lesion in medical and surgical problems seems very great, for unexplained pleurisy with effusion and unexplained ascites are problems that occasionally confront our internists. They must be made aware of the possibility of a simple tumor being responsible for such conditions. The surgeon who found ascites and hydrothorax in a patient with a tumor of the abdomen or pelvis might reasonably feel that a malignant lesion was responsible. It is essential therefore that this entity be known to him, for what could be more satisfactory than to cure such a condition by the simple removal of a benign tumor? Many of us have seen ascites suspected as being of malignant origin cured by the removal of a fibroma, when exploration seemed justifiable because the tumor was movable, but who of us would be daring enough to advise removal of a pelvic tumor accompanied by ascites and fluid in the chest? It is evident that such a patient would be doomed as inoperable, unless it were remembered that this particular entity might be due to a fibroma of the ovary. We feel that such a group of cases should make an impression upon many physicians and surgeons. It is hoped that by their making use of the knowledge some women will escape inevitable invalidism.

Carcinoma of the retained cervix or subtotal VS. Total hysterectomy

Abstract The most important considerations are the large percentage of nulliparas developing cancer of the retained cervix, the large percentage of cases with fibroids in the series, and the very small percentage of occurrence of this cancer as compared to the general impression in the literature of today. Conservative surgery should be the rule, and the life of the patient the most important consideration. There is no doubt, and no one will deny it, that total hysterectomy is a more formidable and more serious operation than simple subtotal removal of the uterus. The morbidity, the chance of injuring the ureters and bladder, the possibility of vaginal prolapse and the foreshortening of the vagina in the young married woman all are against this operation as a routine. The proper method of attack in cases needing hysterectomy is to carefully inspect the cervix in lithotomy position, and to curette at least the endocervix in the young and the whole uterus in the old. If the cervix looks suspicious it should be repaired, amputated, or biopsied, and no further operation should be done until a frozen section has been made, but if no pathologist is available for a frozen section, it is better to wait three or four days for a laboratory report and the presence or absence of cancer determined. The curettings should, of course, be subjected to examination. If cancer is present the proper procedure can be outlined, such as total hysterectomy, total vaginal hysterectomy, or radium. If no cancer is present a subtotal removal of the uterus can be done with ease of mind and the knowledge that the very best treatment had been outlined for the patient. A diseased cervix should never be left untreated; it should be removed or repaired by whatever means the individual surgeon is best fitted to do it, either by amputation, repair, or total hysterectomy. Cauterization is a safe procedure also, and it is perfectly sound to rely upon it if it is done thoroughly and deeply enough. The author does not advocate total hysterectomy routinely but does advocate it in those cases where repair or amputation is difficult and where cauterization is out of the question. The doing or not doing of a total hysterectomy is up to the individual surgeon and to his study of the individual case, and no dogmatic rules can be laid down. Too much serious criticism of subtotal hysterectomy and too much enthusiasm for the total operation can and will of necessity cause an increasing number of deaths and many invalid patients. The work of Hinselmann and Schiller in enabling the surgeon earlier to detect leucoplakia in its various types by the use of the colposcope and Lugols solution should aid in the proper selection of cases for total removal of the uterus. Certainly leucoplakia, although not always developing into cancer, is a precancerous lesion. It occurs in the unmarried as well as the married and proper recognition of such cervices might lessen the incidence of cancer and thus save many more lives than routine total hysterectomy and its accompanying mortality.

The cytologic method in the diagnosis of cancer.

TO MAKE a balanced judgment is always difficult. It is a human failing to see things either black or white and, often with insufficient evidence, to render an immediate and final decision either fo...

The surgery of advanced pelvic cancer in women.

IT has been established that removal of all the pelvic viscera can be accomplished with a mortality of 25 per cent or less and that the resultant physiologic readjustments permit a comfortable and ...

Menstrual dysfunction due to emotional factors

A MENORRHEA and abnormal bleeding constitute two of the most frequently encountered symptoms in gynecologic practice. Evidence has accumulated within the past decade to suggest that menstrual abnormalities may be caused not only by organic, but also by emotional factors, and that, when the latter are primary, surgery and endocrine treatment are often useless. In such cases, therapy must be directed to the cause rather than to the symptoms; in other words, the person presenting the abnormality of menstruation, rather than her organs, becomes the object of therapy.

Clinical, psychiatric and psychoanalytic study of a case of male pseudohermaphroditism

Abstract A case of pseudohermaphroditism was studied clinically, psychiatrically, psychoanalytically and from the hormonal point of view. Structurally the patient was preponderately a male with nonsperm-producing testes. The hormonal studies showed an increased urinary excretion of follicle-stimulating hormone after laparotomy and biopsy of the testes. This increased excretion of follicle-stimulating hormone was not present before operation. The urinary androgens were well within the normal range for males and females. The psychiatric and psychoanalytic studies indicated that the patient had an emotional and psychosexual development typical for females.

Residual carcinoma in the vaginal cuff after radical hysterectomy with bilateral pelvic lymph node dissection

Abstract An invasive or in situ cancer of the cervix may occasionally extend in an unrecognized form beyond the gross tumor and thus inadvertently be left behind. Such extension of cancer will be recognized only on histologic section and will necessitate a second operation. In the Vincent Memorial Hospital this complication has occurred seven times in 300 cases, or in 2 per cent. One patient died of recurrence without further therapy. Five patients have been reoperated upon and in three cancer was found in the material removed at the second operation. This complication can be dealt with effectively if the surgeon and the pathologist are both aware of its possible occurrence.

Gynecology; the vaginal smear.

THE mammalian female genital tract is lined throughout with epithelium that grows and recedes in response to alterations in the concentration of ovarian hormone.1 In the vagina, cyclic changes are ...

Presentation of the Henry Jacob Bigelow Gold Medal

THIS evening we meet to do honor to one of our own. Elliott Carr Cutler received his degree in 1913 from Harvard Medical School, where he was a member of the Boylston Medical Society, Alpha Omega A...