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UWOMJ Volume 25, Number 4, November 1955 Western University Western University Scholarship@Western University of Western Ontario Medical Journal Digitized Special Collections 11-1955 UWOMJ Volume 25, Number 4, November 1955 Western University Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons Recommended Citation Western University, "UWOMJ Volume 25, Number 4, November 1955" (1955). University of Western Ontario Medical Journal. 244. https://ir.lib.uwo.ca/uwomj/244 This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected]. Office Gynaecology W. Pelton Tew, M.B., F.R.C.S., Edin. & Can., F.R.C.O.G. The term gynaecology means the treat­ Special articles of equipment: This ment of diseases peculiar to the female would include a biopsy punch (sterilized), genitalia, and office gynaecology, of an Ayres spatula for taking cervical course, refers to the management or treat­ smears, a microscope and suitable stains, ment of the diseases peculiar to the fe­ a small incubator is very handy, insufflator male genitalia and these diseases are such for treating trichamona and some special that one is able to properly manage or solutions or powders used for specific to treat them in the office. Besides this, treatments of trichamona and the yeast of course, there are certain diagnostic fungus, an electric cautery for cervical procedures which may be carried out in catarrh cases. Other special items may be the office. The same rule applies in the added as found necessary. office as in the hospital, namely, before Your gynaecological patients may be you can properly treat any disease you divided into three common groups: must firstly arrive at your diagnosis. There are three cardinal essentials for (a) the young adoleJcent patientJ. aiming at a proper diagnosis: (b) patientJ in the child-bearing age. (a) a good clear cut hiJtory. (c) the menopau1al and poJt-menopauJal (b) a general phyJical exami1zatio11. patientJ. (c) the functional inquiry. Before carrying out a pelvic examina­ With these in mind you are prepared to tion for the younger patients, you must proceed with your diagnostic investigation. have the patient's mother or guardian present and obtain her consent before do­ ing a pelvic examination. Such a patient ESSENfiAL OFFICE EQUIPMENf may be examined by rectum at first and if necessary the vaginal examination may For a proper and thorough examination be done under an anaesthetic. This patient of any gynaecological patient you will must be 18 years of age before she need at least certain essential articles of accepts responsibility herself regarding equipment, such as : a private and well­ pelvic examination. The common reasons lighted room, an examining table with a for the younger patients seeking advice moderately firm mattress, a goose-neck from a gynaecologist are as follows: light or one similar, adequate supply of clean linen, including sheets for draping (a) late puberty. the patient, a tray on a table beside the (b) irregular periodJ. examining table and this tray should in­ (c) epimeno"hea. clude the following at least: a bivalve (d) meno-metrorrhagia. speculum, sponge forceps, gauze or cot­ ton wipes, waste dish, culture tubes, glass (e) vaginal diJrharge. slides for smears, sterile applicators for (f) lower abdominal pain. taking smears and a pair of clean gloves. (g) enlargement of the lower abdomen. •Professor of Obstetrics and Gynaecology, University of Western Ontario. NovEMBER, 1955 97 ---Office Gynaecology--------------- We usually do not worry about late symptoms and a feeling of something puberty until the girl is 16Yz years old, coming down, and bleeding. Post-meno­ providing she is a reasonably healthy girl. pausal bleeding means carcinoma from Also the irregular periods need cause no some pelvic organ until you prove it is special concern until she is 16Yz years not. A definite diagnosis of such bleed­ old. Meno-metrorrhagia requires a thor­ ing will usually always require a cervical ough investigation - including a gen­ biopsy and/or a dilatation and curettage. eral physical examination, a pelvic ex­ amination and usually always a dHatation and curettage. SOME FINAL HELPFUL LESSONS The women in the child bearing period 1. A good history is invaluable. of life present themselves with more mul­ 2. Do not hurry with the history or ex­ tiple complaints and of course require amination - if you do, you will meticulous investigation. The commoner miss something important. complaints might be summarized as follows: 3. Remember that about 25% of your patients will not have any very seri­ (a) having missed a period. ous gynaecological lesion at all, but (b) irregular periods. will be emotionally disturbed. Pro­ (c) vaginal discharges. per psychological management of (d) pain or discomfort rn lower ab- these patients will pay dividends. domen and back. Remember also that about half of the 25% of patients will not have (e) urinary symptoms. any organic gynaecological lesion (f) any combination of these. whatsoever and only need moral help. If a woman misses a period at this time 4. All women 30 years old or older of life she is pregnant until you prove should have a thorough pelvic ex­ she is not. Meno-metrorrhagia or epi­ amination every six months or more menorrhea require a diagnostic curettage often if necessary for selected cases. always. Suspicious cervices should be biopsied. The vaginal discharges should 5. Pre-requisites for a pelvic examina­ ~ treated according to the causative or­ tion - a cooperative patients in pro­ ganism. Pain is often a baffling problem per position and draped, an empty and will try your investigative powers to rectum and bladder. If the bladder the fullest. The commonest causes of pain is full pass a catheter and not an in this age group may be: opinion. If the rectum is full give an enema before giving a gynaeco­ (a) extrinsic. logical opinion. (b) intrinsic. 6. Post-menopausal bleeding means can­ Extrinsic causes are those outside the cer until you prove it is not. female genitalia or pelvic viscera. In­ 7. Remember there are three possible trinsic causes are those within the female sources of bleeding whenever a wom­ genitalia or pelvic viscera, such as en­ an complains of pelvic bleeding: dometriosis, pelvic inflammatory diseases and ectopic pregnancy. (a) from the cervix or uterus. (b) from the urethra or bladder. Older women at or after the meno­ (c) from anus or rectum. pause come to you with a different symp­ tomatology, e.g., vaginal discharges, vul­ Check all three carefully before mak­ var irritations, vaginal bleeding, urinary ing a final decision. 98 U.W.O. MEDICAL JOURNAL 8. Psychological disturbances are com­ pregnant without 100% good rea­ mon around the time of menopause son, because she may some day come and will require actually more skill back pregnant for sure. in their management than most of 10. Sprinkle a little common horse sense the organic lesions. in all your therapy and it will pay 9. Never tell a patient she cannot get dividends every time. THE DIAGNOSTIC ACCURACY OF that is the percentage of false nega­ THE VAGINAL SMEAR IN CANCER tives was 6.2% plus or minus 1.5%. This was corrected to 2.0% plus or OF THE UTERINE CERVIX minus 0.9% by the removal of those cases in which the presence of malig­ 01/e Kiillgren; A cta Obstetrica et Gyneco­ nant cells could have been masked logica, Scandinavica, Vol. 34, No.3, 1955. by recent previous treatment. (c) Of the 16 false negatives, 5 were .A brief review of the development of adenocarcinoma; that is 5 of 13 cases exfoliative cytology with special refer­ or 38% of adenocarcinoma were in­ ences to the gynecological field and correct while 11 of 244 cases or 4.3% Papanicolaous' technique opens this article. of squamous cell carcinoma were .A discussion of the techniques of taking incorerct. smears, of staining, and of the exami~a­ tion of smears is followed by a descnp­ .According to the author's statistical tion of the celluar elements of a normal analysis, this difference, though large, smear, the criteria of malignancy, and the is not significant, being compatible celluar types found in cases of uterine with the results of other investigators. cervical carcinoma. (d) Thirty-eight cases or 15% were of There are two major diagnostic errors endocervical origin. Of the 16 false possible in the technique: (a~ false ne¥a­ negatives, 9 were endocervical; that tive diagnoses are those w1th negative is 9 of 38 cases or 24% of endo­ smears but positive cancer on biopsy; cervical carcinoma were missed or (b) false positives with positive smears incorrectly diagnosed, while only but no cancer present. 3.2% of portio vaginalis carcinoma were so misdiagnosed. This differ­ The present study involves 257 cases ence is statistically significant, prob­ of uterine cervical cancer found in the ably due to the higher incidence of examination of 3000 smears. The follow­ adenocarcinoma of the endocervix. ing statistics were derived: The author feels that false negative (a) 244 or 95 % were squamous cell car­ diagnoses would be reduced if the smears cinoma, only 13 cases or 5% were were taken from the endocervical region adenocarcinoma. rather than from the vaginal pool. (b) There were 241 correct and 16 false negatives diagnosed from the smears, -Bob McLachlin, Meds '57 NovEMBER, 1955 99 Normal Menstrual Physiology Kay Sandor, Meds '58 INTRODUCTION The phenonema of estrus in the lower animals an.d the menstrual cycle have been well known for many years.
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