Sim B. Lovelady

Extragenital pelvic tumors in women

Abstract Pelvic tumors of extragenital origin are of interest to the obstetrician, since they occasionally obstruct the birth canal at the time of delivery. These tumors are of interest to the gynecologist, since they present problems in differential diagnosis and surgical management. To the pathologist they present a variety of gross and microscopic pictures rarely encountered in any other tissue. Such tumors often simulate tumors of the ovary and fibroid tumors of the uterus. They may be found to arise from the pelvic bones and their surrounding soft parts, from nerve tissue or from some congenital anomaly. They may be freely movable or adherent to the anterior sacral wall. This paper is a clinical and pathologic study of these tumors. Although the literature contains no comprehensive review of extragenital pelvic tumors in women since Levers report in 1843, 1 there are numerous articles reporting on isolated examples and small series of these tumors. Thus Middeldorpf in 1885 2 called attention to the presacral group of teratomas arising from the postanal hindgut. Cragin in 1893 3 emphasized the importance of ectopic pelvic kidneys in the matter of obstructing the birth canal. Utter and Bates 4 and Hundling 5 focused attention on the neurogenic group of presacral tumors; namely, the neurofibromas, ganglioneuromas and ependymal-cell gliomas. Fletcher, Woltman, and Adson 6 found that presacral chordomas as a group were frequently confused with chondromas. Cases of vesical tumors with presacral extension were the subject of a paper by Sheffery 7 in 1946, while Banner, Hunt, and Dixon 8 observed similar extension of a rectal carcinoma. These and numerous other excellent articles 9–22 formed a substantial background for our study of this interesting subject and have made possible a comparison of our own findings with those of others interested in the field.

A preliminary evaluation of Cave's roentgenographic method of fetal cephalometry

Abstract A brief review of the literature relating to roentgenographic cephalometry has been presented. Particular emphasis has been given to the recent work of Cave, and his so-called precision method has been evaluated. If grossly unsatisfactory roentgenograms are excluded—and we are of the opinion that such roentgenograms can usually be excluded—accurate measurements of diameters of the fetal skull in the uterus to within ±6.6 per cent can be obtained by this method in approximately 85 per cent of the cases. In the case of measurements of fetal skulls adjudged to be of grade A in the roentgenogram, accuracy to within ±5.5 per cent was consistently obtained (92 per cent). We believe that a simple, inexpensive, and relatively precise technique of roentgenographic cephalometry might well represent a helpful adjunct in the management of suspected cephalopelvic disproportion in the primigravid woman for whom a trial of labor has been planned and a fetal development above the average is suspected. Although this method, in our limited experience, does not seem to be a method of precision, it is certainly deserving of further investigation.