DEGENERATIVE CHANGES IN THE CYST-WALLS.—The cyst-walls can un dergo the following degenerative proc esses: First, calcification; second, fatty degeneration; third, atheromatous changes; fourth, changes due to infarc tions.
Treatment. — No other treatment is now recognized as worthy of considera tion in the treatment of ovarian cysts Other than their extirpation. Puncture or paracentesis was formerly an ac cepted procedure, but experience has disclosed that it is attended with dan ger. It is but palliative, and presents the possibility of puncture of a large vessel in the tumor-wall, with conse quent haemorrhage; infection of the peritoneal cavity by escape of the con tents of a papillary cyst or colloid ma terial, infection with the cyst followed by inflammation and suppuration, are possibilities which should preclude the practice of this procedure.
OVARIOTOMY.—Extirpation of the tu mor is known as ovariotomy. Success in its performance will depend upon the care with which the diagnosis has been made, the knowledge the operator has as to the condition of the patient, his dex terity in the performance of the tion, and judicious treatment subse quently.
Indications. — It was formerly a rule that patients should not be subjected to an operation until the tumor attained to such size that the patient was ning to suffer inconvenience from the distension. The introduction of the principles of antisepsis and asepsis have rendered such postponement unneces sary.
The large proportion of tumors in which malignant complications result, the danger from injury of the growth and torsion of its pedicle, indicate the necessity for early operation.
Conclusions based upon an analysis of 85 eases of diseases of uterine append ages: 1. It is advisable to do conserva tive operations in all eases in which the ovaries and tubes are not hopelessly dis eased in all parts of their structure, ex cept on patients who are near the meno pause, on patients who have pronounced gonorrhoea of long standing, and on the rare cases of malignant disease. 2. When
a patient is near the menopause (over thirty-five years of age) and has ovarian or tuba] disease of any considerable de gree of severity it is generally wiser to perform complete removal with or with out hysterectomy, according as the uterus also is diseased or not. 3. In cases of well-marked gonorrhoea of long standing, especially if the patient is con stantly exposed to infection, if both tubes are seriously diseased and closed, total removal with or without hysterec tomy is the operation of choice. 4. In certain cases of this class in which the patient thoroughly understands the like lihood that another operation may 1w necessary at some future time and wishes to take the chances in the hope of pre serving the function of menstruation, conservative operation is permissible. 3. If one tube is patent and healthy in ap pearsnee and there is enough healthy ovarian tissue to preserve. a conservative operation ought to be performed even in the presence of gollorrlicea. G. 11 nth present method, of performing resection of the tubes, if both tubes are found closed at the time of operation, subse quent pregnaney is not to be expected. 7. In severe grades of inflammation of the appendages irrespective of causation. if the ostium abdominale of one tube is patent the prospect of subsequent preg nancy after the preservation of a portion of ovary is about one in four and a quarter. or 23 `/, per cent. S. In the le-s severe grades of inflammation under simi lar conditions of tube and ovary the pros pect of subsequent pregnancy is about one in two and a quarter, or 44 per cent.
in women who have borne children, in both classes• subsequent pregnancy may be expected in 35 per cent., whereas in previously sterile women it may be looked for in only 5 per cent. 10. If it is necessary to remove both ovaries it is of no advantage to preserve any portion of tuba] tissue, but, except under the conditions just enumerated, some ovarian tissue should he preserved in every erase.