Contribution to the study of tubal pregnancy / by M. Muret.

  • Muret, Maurice.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Contribution to the study of tubal pregnancy / by M. Muret. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    BO much the more as a fold with fringed edge connects the ostium abdominale and the ovary ; however, only one fimbria can be traced with certainty on the upper circum- ference, while the others are not to be found in the numerous fibrous pseudo-mem- branes. The hsematocele was firmly adherent to the abdominal end of the Fallopian tube, and, as already mentioned, it was torn from the tube during the operation. The Fallopian tube, which at no point shows injury of the wall, is cut open longitudinally from the uterine end. It presents a normal appearance for the first portion, but cm. from the uterus the lumen becomes very narrow, and the channel takes a sinuous course. A probe is passed with difficulty to the extent of about 1 cm., when somewhat suddenly the enlarged ampulla is reached, which has a circumference of about 2^ cm. at the widest part, while the wall is 4 millimetres thick. The ovary, which is about 4§cm. long, 2Jcm. broad, and IJcm. thick, is adherent to the back surface of the broad ligament and the Fallopian tube. There is a hajmatoma on the upper surface about the size of a nut. The htematocele forms a longish oval tumour the size of a fist—length, 7cm. ; breadth, 5cm. ; and thickness, 4cm. The upper surface was of a yellowish-white colour in its fresh condition, and showed roughness and torn adhesions. A section through the tumour proves it to consist of a whitish-yellow capsule, with uniform brownish-red contents flowing from it. The large coagulum, semi-solid in its fresh state, is without difficulty enucleated from the hard capsule as from a shell, and is throughout of the same consistence. I am indebted to the kindness of my colleague. Dr. M. B. Schmidt, privat-docent at the University, first assistant in the Pathological Institute, for the microscopic examination of the specimens, and I here beg to return him my best thanks. His report runs as follows : “ Microscopic examination of the outer end of the Fallopian tube, which is to the naked eye an apparently straight line, shows that the absence of fimbria3 has not been caused by a recent tearing or cutting. The mucous membrane projects slightly beyond the free end, which is smooth, and the wall shows here a slight cellular infiltration in all its coats, while in the other parts of the tube only clusters of cells are found scattered here and there around the vessels. Within the infiltrated portion some granular blood-pigment is strewn, which is not found in any other portion of the tubal wall. On all portions of the tubal mucous membrane subjected to examination, normal columnar epithelium is found, not flattened. Nowhere are decidua cells discoverable. “ The white capsule containing the red mass of coagulum is pretty sharply defined from the latter, but thin pieces remain attached to the whole of the inner surface after enucleation. The capsule, which is 3mm. thick, is shown histologically to be a membrane in process of organisation, with blood vessels passing from without inwards at pretty wide intervals, and in approximately perpendicular direction, and giving off small branches on all sides. The outer strata contain connective tissue, while the inner strata show more and more hyaline reticulated substance. Flaky pigment lies on all parts of the capsule ; elastic filaments can nowheie be seen, not even upon applying specific colouring. Microscopically, the dividing line between capsule and coagulum is neither quite sharp nor straight; on the contrary, numerous blood vessels accompanied by new tissue pass everywhere from the former into the coagulated mass. The impression made is that of a progressive organisation of the coagulum from without inwards. The search for chorionic villi was negative, but it could only be undertaken with the hardened specimens. “ Microscopic examination of the deeply cleft anterior lip shows squamous epithelial carcinoma, the alveoli burrowing deeply among the muscle fibres. The mucous membrane of the rough part of the fundus is greatl thickened, which arises chiefly from increase of the glandular elements ; here and there single gland tubes penetrate