Pelvic promontory fixation of the vaginal vault in sixty-two patients with prolapse after hysterectomy.

During a 20 year study period from 1969 to 1991, 62 patients underwent abdominal colpopexy between a prolapsed vaginal vault and the cartilage of the promontory. A simple surgical operation technique introduced in 1954 was modified and tested on these women. Hysterectomy, either transabdominal or vaginal, had previously been performed upon all of these patients. In some instances, short lyodura loops were used to suspend the vagina. In all operations, the suspension was covered with peritoneum of the lumbosacral area. Functional and cosmetic results were excellent and urinary stress incontinence could often be improved. It is suggested that this type of procedure is indicated in subtotal and total prolapse of the vagina after hysterectomy in patients who desire to preserve sexual function.

[Successful pregnancy after laser surgery of blocked tubes (author's transl)]. / Erfolgreiche Schwangerschaft nach Laseroperation von verschlossenen Tuben.

The application of Laser rays to gynaecology is a recent development and the use of Laser Coherent 400 is reported at the Department of Obstetrics and Gynaecology, Kaiser Franz Josef hospital, Vienna. The Laser apparatus was primarily used for the treatment of benign lesions of the cervix. 3 cases of sterility as a result of blocked tubes have been operated on with Laser rays for the first time. One of these patients became pregnant 4 months after the operation and was subsequently delivered quite normally; this case is briefly reported. It is possible that, in future, operations of blocked tubes with Laser will give better results than conventional surgical treatment.

[Rare gynecological operations (author's transl)]. / Ungewöhnliche gynäkologische Operationen.

1. 13 years old girl with a cystic ovarian tumour of the size of a child's head and an uterus bicornis with a left sided hematometra, caused by a septum; therapy: splitting of the septum and resection of the left uterine horn and left adnexa. -2. 33 years old woman with sterility since 10 years; therapy conservative myomectomy; 2 normal deliveries 1 1/2 and 3 years later. -3. 21 years old girl with an inflammatory tumour grown together with the intestines, urinary bladder and pelvic wall; very difficult exstirpation of the uterus and the adnexa. 4.- 73 years old woman with a tumour of the size of a child's head; difficult mobilisation and exstirpation of the tumour (cholesteringranuloma of the bladder). -5. 56 years old woman with a tumour of the size of an apple at the pelvic wall; very difficult exstirpation of the tumour (primary cancer of the ureter) with resection and reimplantation of the ureter.

[First report on a cholesterol granuloma of the urinary bladder (cyst of the urachus) (author's transl)]. / Uber ein Cholesteringranulom der Harnblase (Urachuszyste).

The authors present a report on a successfully operated cholesterol granuloma of the urinary bladder in a 73 years old female. As suggested by its topography, the granuloma is best explained, in terms of its origin, as a cyst of the urachus. Its development is thought to be due to an inflammatory mechanism with resultant tissue destruction which triggered the endogenous release of the cell-bound cholesterol. These cholesterol substances, when freely deposited in the tissue, appear to give rise to extensive granulomatous foreign body reactions.

[Ten-year record of surgical treatment of gynaecological carcinomas at Kaiser-Franz-Josef Hospital (author's transl)]. / 10 Jahre operative Behandlung gynäkologischer Karzinome im Kaiser-Franz-Josef-Spital.

Brief reference to surgical techniques applied to carcinomas of the cervix, corpus, and ovaries is followed by a comprehensive report in greater detail on carcinoma patients treated between 1969 and 1978. Mention is made first of carcinoma of the cervix, with particular reference being made to its preliminary phases, including basal hyperplasia, dysplasia, carcinoma in situ, and microcarcinoma. No patients in preliminary phases at all had been admitted to hospital in 1969, but almost 100 patients per annum were hospitalised more recently, in the wake of extended routine testing, including colposcopy, Papanicolaou's diagnosis, and checks by reflected light. The total number of patients admitted over the ten years under review has been 476, with carcinomas being detected in most of them by conisation. Wertheim's radical surgery with lymph node exstirpation was applied to 221 cases of invasive carcinoma of the cervix. Hysterectomy, with both adnexa involved, and lymph node exstirpation were applied to 154 cases of corpus carcinoma. The uterus only, but usually together with the adnexa, was removed in 19 cases. Surgery was applied to 109 cases of ovarian carcinoma, with adnexa being removed, in some cases with hysterectomy and omentumectomy. Also admitted were 17 patients with different types of carcinomas and eleven cases of uterus sarcoma. Surgical treatment was given to 984 of 1,130 genital carcinomas, bringing the overall operability rate to 87 per cent. Primary therapeutic irradiation was decided for most of the other patients. Ther overall mortality was 1.6 per cent (16 cases).

[Prophylaxis and early diagnosis of cancer of the cervis (author's transl)]. / Fortschritte der Medizin in Einzeldarstellungen, XXXI.

As a means to early detection of cancer of the cervix Hinselmann invented the colposcope in 1925, Papanicolaon the smear technique in 1943 and Antoine and Grünberger the colpomicroscopy in 1949. A more detailed description of colpomicroscopy is given. The healing of a benign erosion by electrocoagulation or freezing is a prophylactic measure to prevent development of cancer of the cervix. With suspicious findings on routine examination (colposcopy, Papanicolaou, colpomicroscopy), the lesion must be checked by conisation. Removal of the entire lesion (basal hyperplasia, dysplasia, concer in situ) obviates the need for further therapy. Conisation is, therefore, also a prophylactic measure to prevent development of cancer of the cervix. A report is given of 2 series of cases treated at the Department of Obstetrics and Gynaecology, Kaiser Franz Joseph Hospital, Vienna.

[Pelvic promontory fixation of the vaginal stump in cases of prolapse (author's transl)]. / Promontoriofixur bei Prolaps des Scheidenblindsackes

The choice of operative technique in cases of prolapse of the vagina following hysterectomy is difficult in women still having intercourse. Amreich's original procedure of sacrospinal fixation of the vagina, recently recommended by Richter, is difficult and dangerous. Hence, the relatively easy procedure of pelvic promontory fixation of the vaginal stump described many years ago by G.A. Wagner was performed on 5 women with excellent results. A description is given of the operative technique.

[Wertheim's radical operation with vaginal reconstruction by means of the signoid colon in young women (author's transl)]. / Wertheimsche Radikaloperation mit Sigmascheide bei jungen Frauen

Brief mention is made of previous attempts at the formation of an artificial vagina after Wertheim's operation with amnion and freely-transplanted omentum, which did not, however, yield good long-term results. This paper deals with a technique of artificial vaginal reconstruction by means of a stalked segment of the sigma, immediately after completion of the Wertheim procedure, as described and recommended by Novak, Ljubjana. Six women aged from 30 to 33 years have been operated on by this procedure. A follow-up examination one year after the operation revealed an excellent result, because all patients had normal intercourse without any difficulty. Hence this technique of operation is recommended in young women with cancer of the cervix.