Air Pollution and Bronchitis
Air Pollution and Bronchitis
复制标题
空气污染与支气管炎
作者：
C. Daly
was 220°. There was no abdominal tenderness or guarding. Vaginal examination revealed a swelling, about 5 in. (12.5 cm.) in diameter, arising from the vault and filling the cavity of the vagina. She was bleeding freely. She was examined under general anaesthesia after transfusion. The fundus of the uterus was not palpable on bimanual examination and there was no cervical rim. The swelling in the vagina was irregular and had the consistence of a fibroid. The diagnosis of complete inversion of the uterus associated with a submucous fibroid was made. It was difficult to distinguish between the uterus and the tumour, and, for this reason and because of the poor condition of the patient, it was decided to attempt to replace the uterus instrumentally. A biopsy confirmed that the tumour was a fibroid. An Aveling repositor was inserted and the vagina packced with acriflavine and glycerined gauze. During the next three days the repositor and pack were removed daily, but on each occasion there was severe haemorrhage. The uterus remained inverted. On the third day the repositor was abandoned, but the vagina was repacked daily in an attempt to control the bleeding. In all, 15 pints (8.5 litres) of blood was given by transfusion during these days. On the fourth day the temperature rose to 99.6' F. (37.6° C.) and a high vaginal swab was taken; this subsequently grew Bacteriiumii coli and haemolytic streptococci. During the next 10 days 11,500,000 units of penicillin and 18 g. of streptomycin were given. On the sixth day her general condition had improved and she was again examined under general anaesthesia. A Schuchardt incision 'was made. The fibroid was gripped with a vulsellum, and by using considerable force the uterus and the fibroid were delivered out of the vagina. The uterus was elongated and completely inverted, and there was no cervical rim. The fibroid was 4 in. (10 cm.) in diameter, was submucous and sessile, and was attached to the fundus of the uterus. There was still profuse bleeding from the endometrium. The capsule of the fibroid was incised all round about 1 in. (2.5 cm.) from the uterine wall and the fibroid was enucleated from its bed. The uterus was replaced digitally without difficulty by pressing on the centre of the fundus. As soon as the uterus was in its normal position haemorrhage ceased. Convalescence was uneventful. There was a blood-stained vaginal discharge for three days and thereafter no loss at all. The patient did not complain of pain or discomfort. Her temperature rose to 101° F. (38.3° C.) on the two evenings following operation and then remained normal. She was discharged 17 days after operation, the haemoglobin then being 780. The uterus was slightly enlarged, anteverted, and not tender. The cervix was patulous, and the external os could admit two fingers. There was no vaginal discharge. Pathological examination of the fibroid showed it to be 4+ by 3 in. (11.4 by 10 cm.) in diameter, with the typical whorled appearance on cross-section.
