A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The _diagnosis_ of the condition is made by bimanual examination
and by observation of the clinical course of the disease. The cystic
disease is very often bilateral. The ovarian enlargement is slow in
development and is always limited. A moderate maximum size is reached
and may persist for years.
_Treatment._--The only curative treatment of follicular cystic disease
of the ovaries is by operation and removal of the tumor. Operation is
required only in those cases in which the suffering is great. The mere
presence of the cystic ovary does not demand operation, whether it
causes physical suffering or not, as in the case of the cystic tumors
hereafter to be considered. It must be remembered, however, that it is
often difficult or impossible to make a differential diagnosis between
follicular cyst of the ovary and a young glandular or papillomatous
cyst, and it is very much safer in all doubtful cases to adopt the
operative rather than the expectant plan of treatment. If, after the
abdomen is opened, the cyst is found to be follicular, the ovary need
not necessarily be removed.
If, at the time of operation, the ovary is found to present but one
follicular cystic cavity, this may be opened and evacuated and part
of the wall may be excised. If bleeding occurs from the edges of the
cyst-wall, it may be controlled by whipping with a fine continuous
suture of silk or catgut. Some operators avoid this bleeding by
opening the cyst with the cautery-knife. In any case the bleeding is
usually slight if a thin portion of the cyst-wall is selected for the
incision. If the ovary is filled with a number of cystic cavities, it
is safest to remove the whole organ. If the woman be young and anxious
for children, the portion of the ovary that contains the cysts may be
excised and the wound in the ovary closed by sutures of fine catgut.
Simple puncture of the cysts does no good. The conservative operation
is especially desirable in case both ovaries are diseased. When but one
is affected, the surgeon need not hesitate so much before performing
oöphorectomy.
If, as is very often the case in cystic disease of this character,
the Fallopian tubes are found closed by inflammatory adhesions,
salpingo-oöphorectomy is usually indicated.
=Glandular Cysts.=--Glandular cysts are also called _multilocular
ovarian cysts_ or _ovarian adenomata_.
It was formerly thought that all ovarian cysts originated in
the Graafian follicles. This view has now been given up by most
pathologists. The follicular cysts that have just been described never
attain a large size, and run a distinctly different course from the
glandular cysts now under consideration.
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