Operative Gynecology (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1920 edition. Excerpt: ...time is that, ordinarily, recurrence is practically certain when the careinomatous infiltration has extended so that it palpably involves the bladder or the rectum or the outlying lymphatic glands or the connective tissue beyond the ureters. When any of these structures are evidently involved, it is practically certain that there are scattered careinoma cells in adjacent deeper and inaccessible tissues, hence these cases lie outside the operable class. There are exceptional cases, for example, of distinctly localized involvement in a slow-growing tumor, where it may be advisable to excise a portion of the bladder or ureter. But for the present, the author feels that, ordinarily, to subject such a patient to an attempted radical operation is to cause her to pass through the dangers and the sutfering of one of the most serious operations in surgery, without any reasonable hope of cure. How extensive is the carcinomatous infiltration? That is the important question, for the answer determines whether or not the patient is to be subjected to radical operation. To determine this absolutely in any ease is impossible. It may, however, be determined approximately. The signs upon which we must depend largely for determining it are the induration (occasioned by the infiltration of the tissues with carcinoma cells and opposing round cells) and the fixation of the uterus, which is present when the infiltration extends out to the pelvic wall. Uterus Movable. If the uterus is freely movable, operation is indicated. Uterus Fixed. When the uterus is not movable, it is then necessary to determine whether the fixation of the organ is due to malignant infiltration or to inflammatory infiltration. If the fixation is due to malignant infiltration, operations...