John B. Montgomery

The incidence of ureteral obstruction in benign and malignant gynecologic lesions

Abstract It has been known for over a century that ureteral dilatation and hydronephrosis might accompany pregnancy, complete prolapse of the uterus, and pelvic malignancy; but it was not until the advent of intravenous urography that the frequent occurrence of ureteral obstruction in conjuction with such lesions as ovarian cysts, fibromyoma of the uterus, and pelvic inflammatory disease became known. During the past decade various clinical and radiographic studies have suggested that the ureter is involved so frequently that urologic study is essential to the proper understanding and correct management of many patients with extensive gynecologic lesions. Study of the urinary tract by intravenous urography in patients with extensive gynecologic lesions has been a routine procedure on the ward service at the Jefferson Medical College Hospital for the past five years. This study is based upon a review of the case histories and radiographic studies † Our purpose is simply to determine the frequency with which ureteral obstruction has been encountered in a group of patients with extensive pelvic disease, and to compare our findings with the observations of others.

A clinical evaluation of the use of radium therapy in the control of benign uterine bleeding

S INCE its introduction into gynecologic practice about forty years ago, radium has been regarded as a satisfactory means of treating benign uterine bleeding. Although certain defects and inadequacies of the method have been recognized, its wide utilization has not been seriously challenged until recent years. In 1936 Norris and Behney” stated before this Society that “radium irradiation is now generally accepted as the method of choice in the treatment of certain types of uterine hemorrhage of benign origin.” Their paper which reported 1.09 per cent of carcinoma of the genital tract in the patients followed and the subsequent. discussion did not seriously challenge the validity of their opening statement although Eardley Holland of London raised the question as to whether or not radium in the uterus has any effect in promoting the incidence of cancer of the body of the uterus. Pemberton reported upon four patients who developed pelvic malignancy among 425 patients treated and followed for two or more yea,rs. Since then, a number of papers*-lo have appeared which have called attention to the subsequent development of cancer principally of endometrial origin in patients who have been treated with radium for uterine bIeeding of benign origin. These reports have aroused quite a bit of controversy with respect to the wisdom of this procedure. A few similar experiences have prompted us to nndertake an evaluation of our own results with this method which has been the accepted practice in The Division of Gynecology, Department of Obstetrics and Gynecology of The Jefferson Medical College and Hospital. Our material consists of the case records of 1,232 patients treated from 1930 to 1950, inclusive, this period being chosen because of the greater validity of the follow-up records. Four hundred sixty-five were ward patients and 767 were treated on the private service. All of the patients complained of abnormal bleeding. One hundred seventy-six of these had symptoms referable to pelvic floor relaxations which were correct,ed by appropriate vaginal plastic procedures at the time of the radium application. Careful pelvic examination under anesthesia, thorough diagnostic curettage specifically directed toward iscraping the entire surface, particularly the cornual areas, and the cervical canal, together with cervical biopsy in appropriate instances, was customary in every case.

End results in adenocarcinoma of the endometrium managed by preoperative irradiation

Abstract 1. 1. Table XV presents a summary of the 5 year results in 297 patients seen during the 34 years, 1921 to 1954. 2. 2. Irradiation, especially with intrauterine radium, has played a prominent part in the therapy. In operable cases it has been used primarily to devitalize the carcinoma and thereby prevent manipulative spread and local recurrence. 3. 3. The preferred method of treatment has been intrauterine radium followed in 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Sixty per cent of the patients were treated by less satisfactory methods, usually because the carcinoma was advanced or the patient was a poor operative risk.

Evaluation of a new contrast medium for hysterosalpingography.

Summury Visco-Rayopake (diethanolamine salt of 2, 4-dioxo-3-iodo-6 methyl tetrahydropyridine acetic acid) a new opaque medium, which was introduced by Rubin in 1941 has been found to be highly satisfactory for x-ray study of the uterine tubes. The outstanding advantage of this substance is due to the fact that it is well tolerated by the tissues and is rapidly absorbed from the peritoneal cavity. It was used to study the patency of the uterine tubes in 79 patients. In 25 of these, the Visco-Rayopake flowed freely into the peritoneal cavity where it. was absorbed within thirty minutes.

The end results of the simpson operation in sixty-one patients delivered at term

Retroflexioversion acquires a new significance, however, in the childbearing woman, and in the majority of them, at some time requires attention. It may interfere with conception; it is one of the most frequent causes of abortion in the early months of pregnancy; it may be responsible for backache, lower abdominal pain, and almost any pelvic symptom in the woman who has gone through pregnancy and labor.