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SummaryThe development of a new operation for certain types of urinary incontinence has been described. A preoperative test, consisting essentially of temporary elevation and fLxation of the vesical neck and urethra, has permitted the selection of those candidates who have an excellent chance for improvement by the operation, and which at the same time seems to indicate those whose postoperative result will not be good. The operation is a simple elevation and immobilization of the vesical neck and urethra by suturing them to the pubis and rectus muscles. Of 44 suitable cases excellent results were obtained in 36 (82%), significant improvement in 3 (7%), and no improvement in 5 (11%). The causes of most of the failures seem evident and are discussed. The most significant group reported consisted of 25 patients with the common variety of female stress incontinence which had failed to be corrected by one or more standard gynecological procedures for incontinence. Of these 25 patients, 19 have normal control ...

An analysis of 634 young mothers 16 years of age or under who were delivered in the 3-year span including 1945 1946 and 1947 at the Gallinger Municipal Hospital of Washington D.C. was conducted. Almost 99% of the young mothers were black. Only 15% were married. Prenatal care was considered generally good or adequate. Only 34 of them or 5.3% had no antepartum care. The most important phase of their management was found to be in the antepartum course. The incidence of maternal complications before the baby is born is high. Of the 211 complications the toxemias comprised 60%. The younger the mother the higher the incidence of the toxemias. Of the 125 instances of this complication almost 3/4 were classified as mild pre-eclampsia about 1/5 of them as severe pre-eclampsia and 5.6% were eclampsia. 85.2% of this group of young mothers were delivered at term about 12% prematurely and about 3% had previable infants. The importance of good prenatal care for the young primigravida cannot be overemphasized. The duration of labor was found shorter the incidence of cesarean section lower the complications of the puerperium no greater and the infantile and maternal mortality decreased.

The selection of twelve patients with urinary stress incontinence forms the basis of this study. Simple vesicourethral suspension as described by Marshall and his co-workers was the procedure used to correct their complaint. An evaluation of the clinical and anatomical findings observed before correction, particularly with the aid of cystography, showed that failure of the pelvic floor, especially of the levator ani, to support the vesical sphincter mechanism was most frequently associated with loss of urinary control. Cystography postoperatively revealed the striking degree of elevation of the bladder and its outlet effected by the operation. It further demonstrated that the procedure fixes the urethra to the posterior surface of the symphysis without distortion. Although suprapubic vesicourethral suspension is not meant to supplant the standard vaginal operations for the relief of stress incontinence, some of the advantages are enumerated. It is indicated, as a result of this study, that the mechanism of the operation's success lies in the fact that it restores a relatively firm point of attachment to the sphincter mechanism of the vesical neck, a major requirement for the normal function of any sphincter.

In this presentation we propose to evaluate and comment upon the facts which have been accumulated from our experience with ectopic pregnancy. The importance of such a study becomes apparent in the light of Williams and Corbit's recent analysis of 101 fatalities from ectopic pregnancy. These authors state that in the decade 1931 to 1940 every eighteenth puerperal death in Philadelphia, every sixteenth puerperal death in New York City, and every twelfth puerperal death in Chicago was due to ectopic gestation. In Philadelphia from 1931 to 1943 the mortality was 4.6 per cent. Within the last ten years reports on the mortality rate have ranged from 3.2 per cent to 8.3 per cent; Fitzgerald and Brewer, 7.8 per cent 1935; Falk and Rosenbloom, 8.3 per cent 1936; Ware and Winn, 8 per cent 1941; Farrell and Scheffey, 3.2 per cent 1943; and Siegler, 3.9 per cent 1945.

1. 1. The formation of endometrium-like mucosa in the Fallopian tube is a tissue abnormality, which is infrequently seen and seldom described. It responds to the ovarian hormones in its functional activity, just as the endometrium does even to the point of menstrual desquamation. 2. 2. Two cases with clinical and histopathologic findings are reported. 3. 3. The theories of origin are briefly reviewed, and it is concluded that Robert Meyer's theory of heteroplasia explains better than any other the process of its development. 4. 4. The differential characteristics are enumerated and contrasted with several pathologic lesions of the tube. 5. 5. Endometrium-like mucosa in the tube carries little clinical value. Interest centers chiefly upon its biologic significance.

The fourth case of thrombotic thrombocytopenic purpura complicating pregnancy has been reported, the subject briefly reviewed, and therapy discussed as to the advantages and disadvantages of medical versus surgical treatment.

Der unkontrollierbare Harnabgang (relative und absolute Harninkontinenz) ist haufig und besonders unangenehm. Die Haufigkeit wird sehr unterschiedlich angegeben (v. Mikulicz-Radecki, Nemir, Middleton). Wenn man nach dem Symptom fahndet und auch leichte Formen berucksichtigt, sind 50 und mehr Prozent der Frauen wenigstens zeitweise und unter bestimmten Voraussetzungen inkontinent. Behandlungsbedurftig werden sich allerdings nur 10–20% von Patientinnen der gynakologischen Sprechstunde fuhlen.