Richard W. Te Linde

Intra-abdominal rupture of pelvic abscesses

Abstract Intra-abdominal rupture of a pelvic abscess is a serious complication of pelvic inflammatory disease but not so frequent as to indicate operative treatment of all cases of pelvic inflammatory disease. A modern method of treatment has been presented that has lowered the mortality from 90 to 12 per cent at the Johns Hopkins Hospital. Vigorous treatment of shock, antibiotic therapy, deflation of the distended stomach and bowel by the Cantor or Miller-Abbott tube are important preoperative measures. Removal of the pelvic source of infection by subtotal hysterectomy with bilateral salpingo-oophorectomy is usually the operation of choice. This should be done promptly and followed by continued therapy of the type instituted preoperatively.

Demonstration of the relationship of carcinoma in situ to invasive carcinoma of the cervix

YOU HAVE ASKED me to write the story of the discovery of carcinoma in situ of the cervix, and I am glad to do so, for I believe it represents an important link in our chain of knowledge concerning cervical malignancy. Twenty-five years ago, cervical cancer had a mortality rate of approximately 75 per cent. Today, with cytology and the correct interpretation of biopsies, the disease is almost 100 per cent curable. In 1900, Cullenl published his classic book on cancer of the uterus. In that volume is an excellent picture of what is today recognized as carcinoma in situ (Fig. 41, p. 57). This picture was taken at the margin of an extensive cervical cancer, The legend to the figure is: “Suspicious changes in the epithelium along the outer margin of a squamous cell carcinoma of the cervix.” I knew Cullen very well, and he had no conception of carcinoma in situ. Schauensteir? in 1908, Pronai3 in 1909, and Schottlaender and Krrmauner” in 1912 pictured similar lesions on the periphery of gross invasive cervical cancers. They called the lesions “Zuckerguss” (sugar icing) carcinoma, believing it to be a method of spread of invasive cancer in some instances. In 1910, Isador Rubin, while studying gynecologic pathology in Vienna, reported 3 cases of “incipient” cervical cancer. His pictures are typical of those recognized as cancer in situ today. I am sure Dr.

TEN YEARS EXPERIENCE WITH CULDOSCOPY: AN ANALYSIS OF 594 CASES

This extensive clinical study establishes culdoscopy as a valuable diagnostic adjunct in certain instances of pelvic disease. By its use many a “diagnostic laparotomy” can be avoided or, on the other hand, an indication for surgical intervention may be clearly established.