Pleuritic effusions frequently occur in cases of ovarian tumor as a consequence of the condition. Effusion develops in sidiously without pain or temperature, is most frequently bilateral, and, if uni lateral, the right side is more commonly aheeted. It is not due to circulatory disturbance, nor to any alteration in the character of the blood, but to a propaga tion of the disease to the pleura, or more frequently to pleuritic reaction from ir ritation transmitted through the dia phragm. Sometimes it is due to an ab normal peritoneal irritation, especially in eases where ascites is present. When a pleuritic effusion not due to acute pleurisy appears in cases of ovarian tu mor, it is a sign of the malignancy of the ea se, especially if We can exclude torsion of the pedicle, suppuration, and rupture of cysts. When the effusion is not (hub to extension of the disease to the pleura or lungs, operative interfer ence is indicated, but operative inter ference must be determined by the situa tion and extension of possible peritoneal foci, as it is in these cases that pleuritic effusion most commonly occurs. l'ara centesis thoracis may, in rare cases, be preparatory to laparotomy, but complete removal of the tumor is the surest way of removing the effusion. G. Resinel:i Pled. News, Jan. 29, '9S).
In ovarian cysts extensive adhesions may develop during pregnancy as well as after delivery. Torsion of the pedicle may follow the emptying of the gravid uterus in consequence of the sudden change in the intra-abdominal pressure. Infection of the cyst during the puer perium is well known, Zetter having re ported twenty-one cases. Gottschalk (Frauenarzt., Nov., 'OS).
The Fallopian tubes are generally lengthened by the growth of ovarian and parovarian cysts. The tubes rarely
become thinner, generally growing thicker, broader, and longer. Table of fourteen cases in which measurements were made post-mortem. These show that the Fallopian tubes in women, ex cept during the pregnancy or the puer perium. measure from 9 to 9 7, centi metres in length, not including the uter ine part of the tube, which is from 0.7 to I centimetre long. The isthmian end has a diameter of from 2 to 4 72 millimetres; the ampulla, from 3 a/, to 5 '/, millimetres. The lumen increases proportionately with the distance from the uterus. Harry Lepma.n (Zeits. f. Heilk., vol. iv, No. 2, 190I).
Diagnosis of Ovarian Tumors.—Diag nosis of ovarian tumors is mainly se cured by physical signs. The questions to be considered are: first, have we a tumor under consideration; second, the existence of a tumor recognized, is it an ovarian growth; third, an ovarian tumor admitted, we ascertain its relations to the surrounding parts, the existence or sence of a pedicle or adhesions; fourth, the variety of ovarian tumor. For poses of convenience of diagnosis ovarian growths are divided into two classes: those small, and situated within the pel vis, and the large, where they rest upon its brim. The abdominal enlargements other than tumors with which the ova rian growth may be confused are obesity, dermoid tumor of the abdominal walls, ventral hernia, tympanites, fLecal accu mulation, distended bladder, and ascites.
In obesity the history of development, the general distribution of adipose, and I he thickness of fat-accumulation in the abdominal wall should be contrasted with the general emaciation which character izes a large ovarian cyst.