DOCSLIB.ORG

Radical Hysterectomy for Carcinoma of the Cervix*

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Radical Hysterectomy for Carcinoma of the Cervix* Radical Hysterectomy for Carcinoma of the Cervix* JOHN J. MIKUTA. M.D. Department of Obstetrics and Gynecology. Division of Gynecologic Oncology, Hospital of the University of Pennsylvania School of Medicine. University of Pennsylvania. Philadelphia. Pennsylvania Radical hysterectomy refers to the removal of chemotherapy. and improvement in pre and the uterus and cervix and, in addition, to the removal postoperative care. Between 1939 and 1951, Meigs of the upper one-half to one-third of the vagina. the performed I 00 consecutive radical hysterectomy parametria and the pelvic lymph nodes. This opera­ operations without a single surgical mortality. This tion, which is commonly called the Wertheim opera­ astounding feat provided the impetus in the United tion. was actually first described by Clark in the States for a revision of thinking about this procedure United States and Ries in Germany. Wertheim's in the post-World War II era. original operation for carcinoma of the cervix con­ Meigs also defined the advantages of utilizing sisted only of a partial parametrial removal and radical hysterectomy in preference to radiation removal of the upper one-third of the vagina. It did therapy for cervical cancer. These are as follows: not include pelvic lymphadenectomy or the removal I. There can be no tumor recurrence in the of the lateral portions of the parametria. cervix itself. The early efforts at radical hysterectomy for cer­ 2. There can be no new tumor growths in the vical cancer resulted in operative and surgical mor­ cervix or upper vagina. tality in the range of 25-75%. In 1903. when it 3. The problem of radio-resistant tumors is became obvious that radiation therapy. available avoided. then only in the form of radium, was effective for the 4. There can be no radiation injuries to the control of cervical cancer. clinicians abandoned the bowel or the bladder. radical hysterectomy procedure in favor of this In addition to the advantages listed by Meigs. limited form of radiation. A few individuals persisted two other important factors can be considered as in performing the operation, and in I 935. the British helpful. The first of these is the ability to preserve gynecologist and surgeon, Victor Bonney, reported ovarian function in young women. The incidence of on 500 consecutive patients on whom he had done metastasis to the ovary in a patient with early car­ radical hysterectomy. His operative mortality was cinoma of the cervix is negligible, and it is possible. 16%. by using radical surgery to preserve at least one In 1939, Dr. Joseph Meigs of Boston decided to ovary. to avoid the onset of the climacteric. The sec­ take a second look at the radical hysterectomy ond aspect is that the gynecologic oncologist will procedure in view of some of the technical advances know the extent of the disease as reported to him by which had occurred in medicine, primarily in the the pathologist after thorough study of the removed areas of blood transfusion, anesthesia, antibacterial specimen. From this not only will the prognosis be known but also additional therapy can be considered. * Presented by Dr. Mikula at the 46th Annual McGuire Lec­ ture Series. December 6. 1974. at the Medical College or Virginia. Also. there are several clinical situations in Richmond. which. given equally available expert radiation MCV QUARTERLY 11(1):41-44, 1975 41 M!KUTA: RADICAL HYSTERECTOMY 42 therapy and radical pelvic surgery personnel and resident to develop the necessary skills. Similarly, in facilities. one might elect a radical hysterectomy the routine practice of gynecology. a physician will approach. These are as follows: not have sufficient numbers of such patients to main­ tain his operative expertise and capability. This I. Previous pelvic surgery (supravaginal or limitation is gradually being overcome by the total hysterectomy) development of training programs in gynecologic on­ 2. Presence of adnexal mass or masses. or cology which include training in the performance of previous pelvic inflammatory disease radical pelvic procedures. The identification and 3. Diabetes mellitus utilization of the gynecologic oncologist who can per­ 4. Pregnancy form such procedures and who limits his area of 5. Radiophobia specialization to the treatment of gynecologic cancer Appreciating what has already been stated with and its problems. is now a reality. A certifying board regard to the advantages as well as the indications for in gynecologic oncology has been developed and in­ the use of radical hysterectomy and pelvic dividuals are being recognized for skill in this par­ lymphadenectomy. there are three significant limiting ticular area. In addition. training programs are now features: available throughout the country for individuals I. The medical condi1ion of 1he pa1ie111. This is already qualified in obstetrics and gynecology. They primarily related to the patient's general condition. can receive additional training for two years to her age. obesity. and the presence of underlying car­ develop these skills. diovascular and other diseases which might inlluence Let us turn to some of the improvements which the development of signiticant operative and have occurred in the results with radical hysterec­ postoperative complications. tomy in the management of cervical carcinoma. As 2. The 1ype and e.\"lenl of 1he malignancy 11·hic/1 is mentioned earlier. the operative and surgical mortali­ being 1rea1ed. In cervical carcinoma. one of the ty was one of the major limiting factors in this limiting factors is the extent of the disease and the procedure. Since Meigs· original series. other writers degree of its parametrial infiltration. From a clinical in recent times have reported series or patients on standpoint. cancers of the cervix favorable for a whom radical hysterectomy was carried out with radical hysterectomy are clinical Stage 1-a. minimal minimal mortality. The inevitable catastrophe will to moderate-siLed lesions which are 1-b. or very early occur from time to time when the surgeon. at times Stage II-a or Stage 11-b tumors. More extensive local overstepping the bounds of good judgement. under­ disease increases the probability of inadequate sur­ takes radical pelvic surgery on a patient and has an gery as well as the risk of cutting through the tumor unfavorable result. In general. the operative and sur­ at the time of operation. Similarly. the presence or gical mortality should be in the range of 0.5%. any tumor which is spread beyond the pelvic area in Scrupulous attention must be given to the the abdomen. particularly lymphatic involvement of thorough preoperative evaluation of the patient. not the para-aortic nodes or liver. is considered a con­ unly from the standpoint of her disease process so traindication to radical hysterectomy approach as is that an operation of this type will not be attempted the finding of any distant metastasis during the on a patient with distant metastatic disease. but also preoperative oncologic evaluation. Finally. radical attention must be given to the general physical condi­ hysterectomy may be utiliLed in patients "ho have tion of the patient. primarily her cardiovascular. minimal. central. post-radiation recurrence in which pulmonary. and renal systems. Infection of the the lesion has not extended to the bladder and rec­ urinary system must be brought under control prior tum. This operation. under proper circumstances. is to surgery. The operation itself must be meticulously preferable to the more extensive and complicated carried out with the knowledge of the extent or the procedure of pelvic exenteration. operation, the patient's condition. and possible 3. The auailabilily of a surgeon 10 pe1fom1 radical complicating factors well known to a competent hysleree/omy. This factor in general provides the medical anesthesiologist. Careful dissection or the greatest limitation to the surgical approach. since pelvis with specific care around the large vessels during the standard gynecologic residency program. and ureters will insure a much lower incidenct: or there is neither the time nor the experience available significant vascular and urinary tract complications in the performance of radical pelvic surgery for the which are the chid" intra-operative problems. Finally. MIKUTA: RADICAL HYSTERECTOMY 43 careful attention to the details of postoperative care has been the practice at the Hospital of the University are essential to avoid the problems associated with of Pennsylvania to evaluate the bladder prior to and pulmonary, bowel, and urinary areas and to reduce after operation by the use of cystometry. A the incidence of thromboembolic phenomena in these baseline measurement of bladder function is ob­ patients. For more detailed descriptions of these tained prior to surgery, and, on approximately day 9 areas of importance in the pre and postoperative or 10 following surgery, a repeat cystometric evalua­ care, one's attention is directed to Nelson's Atlas of tion is carried out. Frequently the bladder will be Radical Pelvic Surgery.* found to be of the autonomous neurogenic type, The major problem creating morbidity with where there is absence of the sensation of filling as radical hysterectomy for cervical carcinoma is well as failure of the bladder to accommodate to fill­ associated with the urinary tract. While Meigs listed ing. If attention is not paid to this alteration in vesical among the advantages of radical hysterectomy the function, the result will be overdistention and avoidance of radiation complications to the bowel overflow incontinence. Generally by the 10th to 20th and bladder, it became evident that there was a day after surgery there will be a gradual return of significant morbidity associated with these structures function toward normal, first with the return of the from radical hysterectomy. In reviewing all of the sensation of filling and the desire to void, and later a complications associated with radical hysterectomy correction of the detrusor function where accom­ at the Hospital of the University of Pennsylvania.
Load more

Recommended publications
  • Laparotomic Myomectomy for a Huge Cervical Myoma in a Young
    International Journal of Reproductive BioMedicine Volume 18, Issue no. 2, https://doi.org/10.18502/ijrm.v18i2.6421 Production and Hosting by Knowledge E Case Report Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature Hatem Abu Hashim1 M.D., FRCOG, Ph.D., Moustafa Al Khiary1 M.D., Mohamed EL Rakhawy2 M.D. 1Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt. 2Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt. Corresponding Author: Abstract Hatem Abu Hashim; Background: A huge cervical myoma (rare) in a young woman is a nightmare of Department of Obstetrics and Gynecology, Faculty every gynecologist owing to the associated technical challenges in performing a of Medicine, Mansoura myomectomy. Moreover, the 2014 US Food and Drug Administration prohibited power University, Mansoura, Egypt. morcellation during laparoscopic myomectomy due to the inadvertent spread of occult Postal Code: 35516 malignancy and an increased risk of iatrogenic parasitic leiomyoma negatively affected Tel: (+20) 502300002 the overall rate of a minimally invasive surgery. Email: Case: This report described our experience with a case of a huge anterior [email protected] cervical myoma (473 gr) in a young nulligravida woman who successfully underwent Received 28 February 2019 laparotomic myomectomy. After an initial diagnosis by Magnetic resonance imaging Revised 6 August 2019 (MRI), we performed preoperative ureteric catheterization. The myoma was enucleated Accepted 17 September 2019 following the footsteps of Victor Bonney, the pioneer of myomectomy, combined with simple additional steps. We did not use preoperative gonadotropin-releasing Production and Hosting by hormone analog, intraoperative vasopressin injection, or uterine artery ligation.
    [Show full text]
  • Looking at the Unborn: Hi S to R I Ca L As P E C T S of Ob S T E T R I C Ult R a S O U N D
    Wellcome Witnesses to Twentieth Century Medicine LOOKING AT THE UNBORN: HI S TO R I CA L AS P E C T S OF OB S T E T R I C ULT R A S O U N D Volume 5 – January 2000 A Witness Seminar held at the Wellcome Institute for the History of Medicine, London, on 10 March 1998 Witness Seminar Transcript edited by E M Tansey and D A Christie ©The Trustee of the Wellcome Trust, London, 2000 First published by the Wellcome Trust, 2000 The Wellcome Trust is a registered charity, no. 210183. ISBN 978 184129 011 9 All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/ Please cite as: Tansey E M, Christie D A. (eds) (2000) Looking at the Unborn: Historical aspects of obstetric ultrasound. Wellcome Witnesses to Twentieth Century Medicine, vol. 5. London: Wellcome Trust. Key Front cover photographs, L to R from the top: Dr Tony Whittingham Mr Usama Abdulla, Mr Thomas Brown, Mr Demetrios Economides Professor Charles Whitfield, Dr Margaret McNay Dr James Willocks, Mrs Lois Reynolds Dr Marcolm Nicolson, Professor Norman McDicken Mr John Fleming, Dr Angus Hall (chair) Mr Thomas Brown, Dr Tony Whittingham Mr Usama Abdulla, Professor Peter Wells Back cover photographs, L to R from the top: Mr Thomas Brown Audience Dr Malcolm Nicolson, Dr Angus Hall (chair) : Professor Norman McDicken, Mrs Alix Donald Dr Norman Slark Professor John MacVicar Dr Angus Hall (chair) CONTENTS Introduction E M Tansey i Transcript 1 List of plates Figure 1. Ian Donald. 6 Figure 2.
    [Show full text]
  • Vaginal Hysterectomy: Step Ladder Technique Without Postoperative Vault Prolapse
    Obstetrics & Gynecology International Journal Editorial Open Access Vaginal hysterectomy: step ladder technique without postoperative vault prolapse Volume 6 Issue 3 - 2017 Editorial Galal Lotfi Obstetrics & gynecology Department, Suez Canal University, Hysterectomy is one of the most practiced gynecologic operations. Egypt In spite of the enthusiasm for laparoscopic and robotic techniques, I Correspondence: Galal Lotfi, Obstetrics & gynecology feel that vaginal route is the best over the abdominal, laparoscopic Department, Faculty of Medicine, Suez Canal University, Ismaila, and even robotic techniques. Training of the technique is simple, add Egypt, Email to that, it is the winner regarding the cost, complications and hospital stay. Received: January 26, 2017 | Published: March 03, 2017 Vaginal vault prolapse is one of the most frustrating complications and the saying “prevention is better than cur” is well applicable in that context. Sir victor Bonney said; the possibility of curing a case of prolapse after hysterectomy without narrowing the vagina, preventing sexual relations is about to be non-existent.1 This explains the surge of papers for correction of such a problem. The index work puts some stress on preventing such a complication by some modifications of the technique of vaginal hysterectomy. Vaginal vault prolapse is either due to loss of normal pelvic support or to omitting the steps that benefit 2. It will be ligated to the ovarian pedicle. of these supportive structures during the operation. Post hysterectomy So, at the end of operation we find that the whole three pedicles are vaginal vault prolapse could be prevented during hysterectomy.2 ligated together on one side with marked stitch.
    [Show full text]
  • History of The
    HISTORY OF THE AMERICAN GYNECOLOGICAL SOCIETY 1876-1981 AND AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS 1888-1981 EDWARD STEWART TAYLOR Denver, Colorado The C. V. Mosby Company ST. LOUIS, MISSOURI 1985 Copyright © 1985 by The C. V. Mosby Company All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or trans- mitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America The C. V. Mosby Company 11830 Westline Industrial Drive, St. Louis, Missouri 63146 Library of Congress Cataloging in Publication Data Taylor, E. Stewart (Edward Stewart), 1911- History of the American Gynecological Society, 1876- 1981, and the American Associate of Obstetricians and Gynecologists, 1888-1981. Includes index. 1. American Gynecological Society—History. 2. American Association of Obstetricians and Gynecologists—History. I. American Gynecological Society. II. American Association of Obstetricians and Gynecologists. III. Title. [DNLM: Gynecology—history—United States. 2. Obstetrics— history—United States. 3. Societies, Medical—history— United States, WP 1 A512T] RG1.A567T39 1985 618'.06’073 85-4768 ISBN 0-8016-5101-8 GW/OB/RR 9 8 7 6 5 4 3 2 1 01/C/088 Contents Preface. ......................................................................................................................................................... 5 Introduction. ................................................................................................................................................
    [Show full text]
  • Background Historical Context
    Cambridge University Press 978-0-521-72183-7 - Abnormal Uterine Bleeding Malcolm G. Munro Excerpt More information Section 1 Chapter Background 1 Historical context Chapter summary Historically, our culture has traditionally viewed even normal menstruation as an aberration, ostracizing reproductive-aged women; this legacy impacts contemporary societal perceptions. Many contemporary religions specify behavior for individuals and couples during menstruation. A given woman’s perception of her own symptoms may be impacted by her cultural and religious context; she may be embarrassed to present her symptoms, or may not know that they are indeed abnormal. Contemporary understanding of the pathogenesis of AUB is based on relatively new observations and evidence. Surgical and pharmacological therapy of AUB are currently in a state of relatively rapid evolution after changing little for a century. Introduction For the majority of those who have chosen to read this book, it is obvious that menstru- ation is a normal component of female reproductive physiology. However, perceptions of menstruation by our society at large may vary substantially by age, by culture, and by religious belief. Indeed, even in Western cultures, societal perceptions of normal men- struation may be impacted more than we’d like to think by our cultural legacies which, until relatively recently, were steeped in a context of medical naiveté. Indeed, as recently as the late nineteenth century, menstruation was described by the academic H. Beckwith Whitehouse as, “one of the sacrifices which women must offer at the altar of evolution and civilisation.” [1] Despite the acquisition of vast amounts of knowledge about the female reproductive system in general and an increasing capability to control menstruation and treat its dis- orders, many of these concepts continue to suffuse our culture, contributing to the plight of women affected by AUB.
    [Show full text]
  • Looking at the Unborn Christie, DA; Tansey, EM
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Queen Mary Research Online Looking at the unborn Christie, DA; Tansey, EM For additional information about this publication click this link. http://qmro.qmul.ac.uk/jspui/handle/123456789/2799 Information about this research object was correct at the time of download; we occasionally make corrections to records, please therefore check the published record when citing. For more information contact [email protected] Wellcome Witnesses to Twentieth Century Medicine LOOKING AT THE UNBORN: HI S TO R I CA L AS P E C T S OF OB S T E T R I C ULT R A S O U N D Volume 5 – January 2000 A Witness Seminar held at the Wellcome Institute for the History of Medicine, London, on 10 March 1998 Witness Seminar Transcript edited by E M Tansey and D A Christie ©The Trustee of the Wellcome Trust, London, 2000 First published by the Wellcome Trust, 2000 The Wellcome Trust is a registered charity, no. 210183. ISBN 978 184129 011 9 All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/ Please cite as: Tansey E M, Christie D A. (eds) (2000) Looking at the Unborn: Historical aspects of obstetric ultrasound. Wellcome Witnesses to Twentieth Century Medicine, vol. 5. London: Wellcome Trust. Key Front cover photographs, L to R from the top: Dr Tony Whittingham Mr Usama Abdulla, Mr Thomas Brown, Mr Demetrios Economides Professor Charles Whitfield, Dr Margaret McNay Dr James Willocks, Mrs Lois Reynolds Dr Marcolm Nicolson, Professor Norman McDicken Mr John Fleming, Dr Angus Hall (chair) Mr Thomas Brown, Dr Tony Whittingham Mr Usama Abdulla, Professor Peter Wells Back cover photographs, L to R from the top: Mr Thomas Brown Audience Dr Malcolm Nicolson, Dr Angus Hall (chair) : Professor Norman McDicken, Mrs Alix Donald Dr Norman Slark Professor John MacVicar Dr Angus Hall (chair) CONTENTS Introduction E M Tansey i Transcript 1 List of plates Figure 1.
    [Show full text]
  • Review Article Caesarean Myomectomy- a Versatile Procedure for Management of Fibroids at C
    DOI: 10.14260/jemds/2015/266 REVIEW ARTICLE CAESAREAN MYOMECTOMY- A VERSATILE PROCEDURE FOR MANAGEMENT OF FIBROIDS AT C. SECTION Miriam George Fenn1, Mini Isac2 HOW TO CITE THIS ARTICLE: Miriam George Fenn, Mini Isac. “Caesarean Myomectomy- A Versatile Procedure for Management of Fibroids at C. Section”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 11, February 05; Page: 1863-1866, DOI: 10.14260/jemds/2015/266 ABSTRACT: OBJECTIVE: To study all Caesarean myomectomies done at a tertiary center in South India. METHODS: 29 cases of Caesarean myomectomies were performed from 2004 to 2014, at our institution – a tertiary referral center. The type of fibroids, number and size of myomas, need for blood transfusions, and operating time and post-operative morbidity at Caesarean myomectomy were studied. RESULTS: We had equal number of subserous and intramural fibroids, and one large sub mucous fibroid removed at surgery. 7 fibroids were very large (> 10 cm diameter). 6 patients had more than 3 fibroids removed at surgery. 8 required blood transfusions, and none of our patients required hysterectomy. CONCLUSION: The authors find Caesarean myomectomy a feasible and safe option in women with fibroids undergoing Caesarean section. KEYWORDS: Caesarean myomectomy, leiomyomas in pregnancy. INTRODUCTION: The incidence of leiomyomas in pregnancy is 2–4%. Elective myomectomy at the time of Caesarean section has been traditionally discouraged due to the attendant morbidity, primarily from haemorrhage. If myomectomy during Caesarean
    [Show full text]
  • This Book Is Amust. This Is Particularly True and Scrape Before Them. The
    Book Reviews exercise in excessive regulation based on tended and weeded by local gardeners. overly abstracted scientific norms. To Many of these men were the most skilled counter this, Warren ends with a call for a diagnosticians or accomplished surgeons in reconstituted coalition of science and public the profession although, of course, other activism. In this sense Brush with death Harley Street practitioners flaunted the participates in the history it chronicles: a same style without having equivalent book written with a rare combination of substance. Perhaps rather less flamboyantly scholarly rigour and passionate public and rather more nervously, display of concern, it provides an intelligent and medical opulence continued during the provocative platform on which to rethink inter-war years, although the Rolls-Royce our place in our leaden world. and the Daimler replaced the horse-drawn carriage. Democratic sentiments, socialist Ian A Burney, doctors and a murmuring about state Wellcome Unit for the History of Medicine, medicine no doubt fostered this slightly University of Manchester more muted statement of the profession's ideal place in society. Victor Bonney was born in 1872, the son of a general practitioner living in Chelsea. G Chamberlain, Victor Bonney: the Under the tutelage of John Bland Sutton at gynaecological surgeon of the twentieth the Middlesex Hospital and the Chelsea century, Carnforth, Parthenon Publishing, Hospital for Women, this promising young 2000, pp. xi, 140, illus., £19.95, US$29.95 man had by the First World War become (1-85070-712-X). one of the most skilled general surgeons, with particular dexterity in gynaecological operations, to grace the London scene.
    [Show full text]
  • GYNAECOLOGY Professor W
    THEr BRTTTSR 714 APRIL 22, 19331 UTERINE ACTION AND ITS ABNORMALITIES [MEDICAL JOURNAL i natal period, and thus help to annihilate the dread CONGRESS OF OBSTETRICS AND of labour. GYNAECOLOGY Professor W. BLAIR-BELL, Dr. M. M. DATNOW, and Dr. T. K. JEFFCOATE presented a paper on the mechanism of uterine action and its disorders. In vivo and The ninth British Congress of Obstetrics and Gynaeco- in vitro experiments on animals were described and graphs of logy was h3ld at the University of Birmingham on April 5th, 6th, and 7th, under the presidency of Professor uterine contractions shown. In woman the anterior pituitary hormone was in excess in the early months, BECKWITH WHITEHOUSE. The foreign visitors were Pro- fessor Oskar Fraenkl of Vienna, Professor Van Rooy of but diminished as pregnancy continued, and by the fourth month the influence of the corpus luteum was on Amsterdam, and Professor Birger Lundqvist of Gothen- the burg. wane. The function of the corpus luteum varied quanti- tatively and qualitatively in different animals. Neither UTERINE ACTION AND ITS ABNORMALITIES oestrin nor " antuitrin S " had any effect on the isolated At the morning session on April 5th, with Professor uterus ; oestrin sensitized the uterus to respond to infun- Whitehouse in the chair, Mr. ALECK BOURNE read the open- dibulin, and it assisted in bringing about hypertrophy ing paper, " The Uterine Action and its Abnormalities." and increased vascularity of the uterine musculature He said that feeble contractions were the cause of many during pregnancy. The hormone of the corpus luteum of the disasters of labour. For the child the long labour inhibited uterine activity ; but after the first two months was a considerable risk.
    [Show full text]
  • Belly-Rippers, Surgical Innovation and the Ovariotomy Controversy Sally Frampton Faculty of English University of Oxford Oxford, UK
    medicine and biomedical sciences in modern history sciences modern in biomedical and medicine BELLY-RIPPERS, SURGICAL INNOVATION AND THE OVARIOTOMY CONTROVERSY SALLY FRAMPTON Medicine and Biomedical Sciences in Modern History Series Editors Carsten Timmermann University of Manchester Manchester, UK Michael Worboys University of Manchester Manchester, UK The aim of this series is to illuminate the development and impact of medicine and the biomedical sciences in the modern era. The series was founded by the late Professor John Pickstone, and its ambitions refect his commitment to the integrated study of medicine, science and tech- nology in their contexts. He repeatedly commented that it was a pity that the foundation discipline of the feld, for which he popularized the acronym ‘HSTM’ (History of Science, Technology and Medicine) had been the history of science rather than the history of medicine. His point was that historians of science had too often focused just on scientifc ideas and institutions, while historians of medicine always had to consider the understanding, management and meanings of diseases in their socio-economic, cultural, technological and political contexts. In the event, most of the books in the series dealt with medicine and the biomedical sciences, and the changed series title refects this. However, as the new editors we share Professor Pickstone’s enthusiasm for the inte- grated study of medicine, science and technology, encouraging studies on biomedical science, translational medicine, clinical practice, disease histories, medical technologies, medical specialisms and health policies. The books in this series will present medicine and biomedical science as crucial features of modern culture, analysing their economic, social and political aspects, while not neglecting their expert content and con- text.
    [Show full text]
  • Extended Radical Vaginal Hysterectomy for Cancer of the Cervix
    EXTENDED RADICAL VAGINAL HYSTERECTOMY FOR CANCER OF THE CERVIX BY SuBODH MITRA, M.B. (Cal.), DR. MEn. (Berlin), F.R.C.S. (Edin.), F.R.C.O.G., F.A.C.S., Professor-in-charge, Department of Obstetrics & Gynaecology, R. G. Kar Medical College; Director, Chittaranjan Cancer Hospital, Calcutta. There is an old saying that ''in the treated rather indifferently till, to­ history of science . , the past is wards the end of the 19th century never past but continues and is very and the beginning of the 20th cen­ active in every form and at every tury, Wertheim and Schauta (both manifestation of the present" ( Costi­ from Vienna) took up the surgical glioni). The same is equally true in work with scientific prec1s10n and the progress of the scientific treat­ started doing radical hysterectomies ment of cancer of the cervix. With­ abdominally and vaginally. out going much into details, the pro­ During this era, the investigation gress of the treatment can be divi­ was s:arted to assay the results of ded into different eras, namely, Pre­ cancer treatment on a statistical Wertheim, Wertheim-Schauta, radio­ basis. I think, it would not be out therapy and the modern era. In 1878 of place here to state clearly a few surgical interference was introduced fundamental rules of cancer statistics. in the treatment of cancer of the In order to assess the surgical cervix by Freund and Czerny, i.e. achievement of a series of cancer about a quarter of a century before cases, it is essential to know the Wertheim and Schauta came in the surgeon's operability rate, i.e.
    [Show full text]
  • Copyrighted Material
    CHAPTER 1 Introduction and prologue Surgery remains only as safe as those wielding the At the same time, there has been a marked scalpel. reduction in the number of hysterectomies performed Tito Lopes as a result of more conservative management options for dysfunctional uterine bleeding. In the nine‐year period from 1995 to 2004, there was a Introduction 46% reduction in the number of hysterectomy operations performed in NHS hospitals in England Surgical training and between 2008 and 2012 there was a further Surgical training in gynaecology has seen dramatic 7% fall in hysterectomies in the UK. changes in both the UK and the USA over the past With the increasing use of laparoscopic surgery 20–30 years. When the current editors were in in elective gynaecology, including for hysterec- training, there were no restrictions on the number tomy, the ‘open’ approach to gynaecological surgery, of hours that they could be asked to work. It was traditionally the surgical ‘bread and butter’ for common to be resident on call every third night in trainees, is also on the decline. Equally, a large addition to daytime work, which often resulted in number of ectopic pregnancies are now managed a working week in excess of 110 hours. In the UK, conservatively meaning that trainees are lacking the European Working Time Directive was exposure to emergency laparoscopic surgery for extended to junior doctors in 2004 thereby reduc- tubal pregnancies. ing the working week to an average of 48 hours. It is vital that standard safe techniques continue In the United States, the Accreditation Council to be taught to all trainees.
    [Show full text]