Fibroid tumors of the uterus are tumors of muscle and connective tissues. They constitute the most common type of pelvic tumor, occurring in about 20 per cent of women of 35 years of age or older. They are characteristic of sexual maturity. The vast majority of them occur in middle life, commonly in the third, fourth and fifth decades.
Fibroids may be as small as a garden pea or as large as a full term pregnancy, although huge sizes are rarely seen today because the growths are usually recognized and removed before attaining tremendous dimensions. Frequently the tumors are multiple and knobby, and cause the womb to be not unlike a lumpy potato, with nodules buried in its wall.
Symptoms
Often a fibroid tumor is discovered in a routine physical examination of a woman who has experienced no symptoms. The growths are painless, in absence of complications, and may be present for many years without causing distress. If enlargement is sufficient to exert pressures on nearby structures, various symptoms depending on size and location may occur difficult urination, constipation, vague feelings of heaviness, disturbances of menstruation.
If the fibroids are small and cause no pressure symptoms or menstrual abnormalities, they need not be treated actively, but there should be an examination every six months or so to keep watch on the situation. Otherwise, the usual treatment is surgical removal. Many factors affect the decision in the case of an individual patient, as evaluated by the doctor. In a procedure called myomectomy, the tumors are removed from their beds and the cavities closed. This operation may be preferred in young women who desire to become pregnant.
In women who are near or past the menopause, the entire uterus may be removed (hysterectomy) instead of excising individual tumors. Tumors of moderate size that cause no symptoms in women near the menopause may just be left alone and watched, since there is some tendency for fibroids to regress after the change of life. When surgery is considered too hazardous for a particular patient, treatment by radiation (x-ray) tends to shrink the tumors.
Ovarian Cysts
The ovary may be the site of various types of tumors, many of which are benign. Some are malignant. A cyst is a sac containing fluid or mucoid material. Several varieties may arise in the ovary. Small cysts sometimes disappear without treatment, but if they enlarge or become twisted they must be removed. A cyst that has a slender stem (pedicle) may twist tightly around the stem, causing intense abdominal pain that may arouse suspicion of appendicitis.
The ovary, as well as being a producer of eggs, produces sex hormones. The ovary secretes estrogen, necessary for feminine development, and progesterone, which is necessary for preparing the uterus for pregnancy. Some tumors of the ovary may cause excessive hormone production. It is not possible to determine the exact nature of an ovarian cyst until it has been removed surgically and examined under a microscope. Generally, cysts exceeding size of an average orange should be removed.
This is a very serious condition most commonly seen in children under the age of two (the average age is seven months). It is caused by one portion of the intestine pushing inside the next segment. The pressure of the outside intestine compresses the blood vessels of the inner loop, cutting off the local blood supply. If not relieved quickly the inner portion of the loop may become gangrenous. This condition is two times more frequent in boys than in girls.
Symptoms
an infant cries out suddenly with violent abdominal cramps and then starts vomiting. The cramps subside and then occur again at fairly regular intervals, leaving the child weak and almost flaccid. But the telltale and most frequent sign of intussusception is blood in the stools. At times only a slight discharge of blood is passed by rectum, but more frequently there is a mixture of blood and mucus which because of its semblance to cranberry or currant jelly has been frequently called a cranberry stool or currant jelly stool.
Treatment
This is an acute emergency and a doctor should be called immediately, for unless the intussusception is relieved it may prove fatal. Often the physician can feel the mass in the abdomen caused by the condition. In rare instances it will subside under manipulation by the doctor. At other times it will subside when the child is given a diagnostic barium enema prior to x-ray or fluoroscopic examination. But if the intussusception is not relieved, an immediate operation is necessary. Time is very important, for if one waits too long and gangrene occurs, an amputation of a part of the intestine may be necessary. This is a very serious and critical operation for a small child already extremely ill and completely prostrated.
