Advanced fibroid study: paying homage to John Sampson.

A recent article supports our longstanding view that all intramural fibroids can cause disturbance of uterine function. This may be reflected in the symptom of menorrhagia or fertility-related issues, as well as pregnancy losses at all gestational stages. However, it was disappointing that there was no reference to either the mechanism by which fibroids disturb uterine function nor to the gynaecologist who described this more than 100 years ago, namely John Sampson. In fact, Sampson's findings about the unique venous drainage mechanism from the endometrium explains how menstrual loss is contained in normal physiology, but which can be excessive when the protective 'anaemic' zone is disturbed. Two more recent and pertinent observations include the hysteroscopic findings of Osamu Sugimoto, who showed in the 1970s that the endometrium overlying submucous fibroids is actually atrophic, hence the oft-cited reason of hyperplastic or excessive endometrium cannot be the cause of the associated menorrhagia. Furthermore, recent imaging techniques describe an additional 'junctional zone' adjacent to the endometrium in cases of fibroids and adenomyosis. We believe this all adds up to disturbed venous drainage as described by Sampson and needs to immediately enter the educational training of medical students, doctors and gynaecologists worldwide.

Surgical diseases of the womb according to Aetius of Amida (6th century A.D.).

BACKGROUND: In the interest of presenting historical background for modern-day medicine and surgery, the authors comment on the concepts of the eminent Byzantine physician Aetius of Amida (sixth century A.D.) in surgical treatment of diseases of the womb. STUDY DESIGN: The 16th book of Aetius' work Tetrabiblus, in the original Greek language, a treatise on gynecology and obstetrics of his era, was investigated. Comparison was then made of the relative knowledge among ancient and Byzantine physicians. DISCUSSION: Aetius analytically describes many surgical diseases of the womb (prolapse, abscesses, phimosis, atresia, hemorrhoids, stones, thymos, chaps) and gives a detailed symptomatology and conservative and surgical treatment. His work followed Hippocratic, Roman, and early Byzantine physicians, especially Soranus, the "Father of ancient gynecology and obstetrics" and influenced later physicians of his era and beyond. CONCLUSIONS: Aetius of Amida gives significant information about surgical approaches to diseases of the womb, the most detailed of any medical writer of his epoch. His descriptions, following the Hippocratic and mainly the Hellenistic and Roman traditions, influenced Islamic and European medicine, and through them the rest of the world, constituting the roots of the specialty of gynecology.

History of adenomyosis.

Although the claim has been made that there are early descriptions of what today we call endometriosis and adenomyosis in theses presented in Europe in the late 17(th) and during the 18(th) centuries, the first description of the condition initially named 'adenomyoma' is that provided in 1860 by the German pathologist Carl von Rokitansky, who found endometrial glands in the myometrium and designated this finding as 'cystosarcoma adenoids uterinum'. Over the following 50 years 'adenomyoma' (and endometriosis) were considered pathologies separate from the so-called 'haemorrhagic ovarian cysts', and it was not until 1921 that this condition was recognized to be of endometriotic origin. The first systematic description of what is today known as adenomyosis was the work of Thomas Stephen Cullen who, at the turn of the 19(th) century, fully researched the 'mucosal invasion' already observed by a number of investigators in several parts of the lower abdominal cavity. Cullen clearly identified the epithelial tissue invasion as being made of 'uterine mucosa' and defined the mechanism through which the mucosa invades the underlying tissue. In 1925, 2 years before Sampson created the term 'endometriosis', Frankl created a name for the mucosal invasion of the myometrium and clearly described its anatomical picture; he called it 'adenomyosis uteri' and explained that 'I have chosen the name of adenomyosis, which does not suggest any inflammatory genesis as do terms like adenometritis, adenomyositis, adenomyometritis, still employed'. The current definition of adenomyosis was finally provided in 1972 by Bird who stated: 'Adenomyosis may be defined as the benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium'.

Emergent obstetric management of uterine inversion.

Puerperal inversion of the uterus is an unusual and potentially life-threatening event occurring in the third stage of labor, but when managed promptly and aggressively inversion can result in minimal maternal morbidity and mortality. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock. In conjunction with anesthesia personnel, immediate uterine replacement should be considered. Uterine relaxants (MgSO4, terbutaline, or halothane) can be used if initial attempts fail; however, in the majority of patients successful immediate replacement without use of uterine relaxants is possible. The choice of anesthetic agent and uterine relaxants should be individualized based on the clinical scenario. Following manual replacement, massage and ecbolic agent(s) should be instituted immediately to prevent reinversion. Surgical repositioning via an abdominal or vaginal approach may be necessary in subacute or chronic inversions.

Hysteroscopy: where have we been, where are we going? Honorary luncheon address.

A quiet resurgence of interest in an old endoscopic technique began in the late 1960s. Today hysteroscopy, both diagnostic and operative, has become an integral part of the gynecologist's technique. The question, "Hysteroscopy: where have we been, where are we going?" can be addressed by an examination of the past, present and future. Tribute will be paid to the pioneers. The clinical applications as practiced today are described. Critical appraisal of the risks and benefits of these procedures will permit predictions to be made about the future of gynecologic hysteroscopy.

Hysteria, or "suffocation of the mother".

OBJECTIVE: To understand or explain the surprising adherence of prominent physicians throughout the centuries to terms suggesting that the womb could move and cause suffocation, choking or difficulty in swallowing. DATA SOURCES: Hippocratic writings on hysterical symptoms and the views of subsequent authors and contexts surrounding such views. DATA SYNTHESIS: Physicians who followed Hippocrates repeatedly related difficulties in breathing or choking and difficulties in swallowing to the uterus, although most recognized that the womb did not rise out of the pelvis, except partially, when enlarged by pregnancy. Respiratory and gastrointestinal symptoms were often associated with anxiety. The effects may have been attributed to the womb, because it was recognized that the womb, when enlarged, can cause difficulty in breathing. Anxiety was also reported more often in women and may have been attributed to the womb for that reason. CONCLUSION: The suffocation of the mother can be understood as anxiety with dyspnea, and globus hystericus reflects anxiety with a choking sensation or difficulty in swallowing.

[Unusual historical cases of uterine inversion]. / Curieuses observations anciennes d'inversion utérine.

Professor Martial Dumont presents four cases of inverted uterus which are quite old. They come from the book by Mr Planque, M.D., entitled: "Selected Medical Library, from periodical publications, French as well as Foreign", published in Paris in 1748, by D'Houry senior, publisher and bookseller of His Royal Highness the Duke of Orleans, rue de la Vieille Boucherie. These findings are reported in Volume One, pages 406-413.

Vesicouterine fistula--a review.

Ninety-two cases of vesicouterine fistula reported in the world literature since 1908 are reviewed. The lesion was rarely seen before 1947. It usually followed a vaginal operative delivery and the usual complaint was total urinary incontinence. Diagnosis was most often made indirectly by seeing urine or dye pass through an intact external cervical os. Management usually involved a vaginal, surgical approach to repair. Since 1947, vesicouterine fistula, while not common, is no longer rare. It occurs most often after low segment cesarean section. While urinary incontinence may occur, the major symptom is cyclic hematuria (menouria). The diagnosis is best made by hysterogram performed with a short-tipped cannula. Management consists of an abdominal, surgical approach, the technique of which varies with the patient's need for future reproductive capacity.