Lester T Hibbard

In women of reproductive age the usefulness of laparoscopy in diagnosing acute appendicitis was evaluated. Eighty-six women underwent diagnostic laparoscopy. There was complete visualization of the appendix in 93% of the patients. Twenty-two patients were spared laparotomy. In the nonpregnant patients, salpingitis was the disease most often confused with appendicitis. Eighty-five percent of the patients with salpingitis had the onset of symptoms within 14 days of the last menstrual ...

The diagnosis and management of endometriosis presents several enigmas. This review, of eight patients with endometriosis involving the urinary tract, from three large clinical services in the City of Los Angeles, highlights some very difficult problems. Not only diagnostic errors but also inappropriate conservatism and inadequate surveillance have led to compromised function, resection, and/or destruction of the kidneys, ureters, or bladder. The series indicates those findings which are ...

A series of 128 cases of adnexal torsion and an additional 97 cases where the preoperative diagnosis of torsion was incorrect are reviewed. The diagnosis is uncertain and surgical intervention is likely to be delayed. The adnexa are seldom salvaged despite the fact that torsion infrequently involves a malignant neoplasm. Laparoscopy is an effective means of reducing the number of necessary laparotomies when a diagnosis of torsion is uncertain.

Prophylactic external cephalic version in a private obstetric practice reduced the incidence of breech presentation at delivery from 3.5 to 2.0 per cent; and the incidence of transverse lie, from 0.4 to 0.17 per cent. Following this procedure, the uncorrected perinatal mortality rate was 2.5 per cent, and the corrected perinatal mortality rate was 0.5 per cent. External version is an effective and reasonably safe method to avoid the alternatives of vaginal breech delivery or cesarean section.

Despite an increased utilization of abdominal delivery, prolonged expectant management, extended hospitalization, and newer methods of diagnosis, the fetal salvage in placenta previa has not appreciably improved in the past 20 years. In one institution the uncorrected fetal mortality was 24.9 per cent (213 infants) in the years 1948–1953 and 24.7 percent (267 infants) in the years 1962–1966. Expectant therapy can be suitably applied to less than half the cases, with the expectation of a ...

Seven cases of ruptured subcapsular hematoma and one case of ruptured hepatoma are reported. Six of the patients died, four following an unsuccessful operation. One patient survived following an operation, and another patient survived without surgical intervention. Both survivors were treated with a gravity suit to control internal hemorrhage.

There have been considerable changes in obstetric practice in the past 5 years, with corresponding changes in the application of ceasarean section to obstetric complications. In this paper, 4,003 cesarean sections done in a public hospital during four time periods dating back to 1948 are compared, and the changing applications of section are discussed. Breech presentation, fetal distress, and dystocia have contributed substantially to the increasing use of abdominal delivery.

The corpus luteum is responsible for a substantial number of emergency operations, some of which prove to be unnecessary and others which are unnecessarily complex. The routine utilization of culdocentesis and pregnancy testing will identify the large majority of those patients who can safely be treated by expectant observation or who should first be investigated by a diagnostic operative technique, such as laparoscopy, before an exploratory laparotomy is performed. When a laparotomy is ...

There have been 17 reported cases of histologically proved thoracic endometriosis and 27 cases of probable thoracic endometriosis based upon repetitive symptoms associated with menstruation and response to suppression of ovarian function. Two additional cases of probable thoracic endometriosis are reported. Seventeen of these 46 patients also had proved pelvic endometriosis and four others had clinical evidence of pelvic disease. In the majority of the cases there has been a delay in ...

A group of 23 cases of secondary abdominal pregnancy are presented. In the majority of cases, complete primary removal of the placenta was accomplished. The factors favoring removal are discussed and some of the hazards noted. Adequate blood replacement is essential. If primary removal of the placenta is not possible, subsequent complications are likely. An early diagnosis favors complete operation because removal is less difficult during the first half of pregnancy.

The endometrial jet washing technique of Gravlee is a satisfactory method of screening for endometrial carcinoma. The uterine cavity can be irrigated with an unlimited amount of fluid under a negative pressure. Cell block preparations of the tissue samples have proved adequate to establish a diagnosis of endometrial adenocarcinoma for 5 of 287 screened patients. Subsequent curettage demonstrated that no endometrial cancers were overlooked.

Twenty-four patients with traumatic rectovaginal fistulas and 27 patients with complete perineal tears underwent secondary operative repair. Primary healing occurred in 50 cases and partial healing in the 51st case. Six patients had previously undergone one to three unsuccessful repairs. The advisability of early repair and the benefits of prophylactic antibiotics and of use of a Martius graft for operative failures are discussed.

In a large medical center, utilization of hysterectomy for sterilization has increased by 293 per cent over a 2½ year period. If only elective hysterectomies not associated with a pregnancy are counted, the increase is 742 per cent. Although the operative results were generally satisfactory, it is far from clear whether the additional risks of hysterectomy are outweighed by the potential benefits to be gained.