A CASE OF ENDOTHELIAL CYST


A CASE OF ENDOTHELIAL CYST.
Read before the Bureau of Surgery, Gynecology and Obstetrics, I.H.A., July 23, 1954.


Read before the Bureau of Surgery, Gynecology and Obstetrics, I.H.A., July 23, 1954.

MARY I. SENSEMAN, H.M.D.

Mrs. D. B., aged 37 years, 1951.

 

I had known this woman since her second pregnancy, Feb., 1934. She had had a lengthy, difficult confinement when her first child was born, but I never learned any specific details about it. The second child, a body, and the third one, a girl, were both occipito-posterior, so deliveries were difficult.

Her general health had always been fairly good. She was always very active, both in her home and in outside interests. She had a little eczema, had excessive cerumen from one ear, her lower wisdom teeth never fully erupted, but abscessed and had to be removed.

She never had had excessive bleeding under any circumstances, menstrual, in accouchement, or from any accidental condition until she had a number of teeth extracted in the latter part of 1950. One of these occurrences spilled blood on wall and on dentist, and he, very competent, had to use all his skill to stop the haemorrhage. After that worst experience, he took special precautions and finally succeeded in getting all teeth out, over about one years time.

In August, 1951, she complained of having a bloody discharge after coition. That had never occurred before. I examined her, found nothing unusual except a trace of blood, and a few days later she menstruated at time due.

She was coming to me frequently then, because eczema on one finger annoyed her. Also, the tooth extractions kept her tired out. The last ones were removed Nov. 15, 1951. A week later she complained of a discharge which she thought was from the bladder. It was brown, watery, and offensive. Menses began Nov. 17, and I examined her Nov. 19. Flow was dark red, had strong odor.

I did not see her again for five weeks, the day after Christmas. Menses had appeared Dec. 17, but stopped in two days. I had left town on Dec. 24, and on that day she began to feel very bad. Had severe pelvic cramps that came on intermittently. Examination disclosed nothing that gave me a clue to the trouble. She had continued to work, and was mild in her complaints. Temperature was 100.8 on Dec. 26, and I considered the trouble to be influenza.

She came to the office Dec. 28, and Jan. 2, 1952, but not again until Jan. 21. Menses had appeared Jan. 14, were copious and painful, but almost ended by Jan. 21. Some dark brown, thick, offensive discharge continued; great pain in pelvis returned. Jan. 26 her temperature was 102. Jan. 27 a haemorrhagic flow began.

Temperature became erratic, varying from 99.6 to 103.4. Pulse was 96, small and weak. Skin became lemon-yellow in color; eyes surrounded by black circles; tongue dry, with white coating, red tip; abdomen tympanitic; small amount of black, very offensive vaginal discharge.

Telephone conversation with a surgeon, Jan. 31, 1952, made me sure it was a case of endothelial cyst. Secale was the remedy at that time. It was an intense battle for three days and nights longer. Pain became localized in left pelvis, but I could not find any mass there. Temperature and pulse continued to vary, the former ranging between 100 and 103.

She was given numerous remedies–Cinnabaris, Anthracinum, Sulphur. Discharge was no longer colored, just a little white mucus. Sleep had been very poor, but appetite had been good all the time. Indications of sepsis continued. The evening of Feb. 4, 1952, I gave Sulfathiazole 1M. She was better the next morning, and temperature was normal the morning of Feb. 6. but rose about one degree by evening of that day. She soon began to get out of bed for her meals. She was a small woman when in health, and had lost ten pounds while ill.

Feb. 18 temperature was 101, and I examined her again on Feb. 20. Pain on pressure at upper left of fundus, but no mass. That evening she entered the hospital to be under the surgeons direct observation. Numerous tests corroborated the diagnosis and ruled out all other probable conditions. Previously, she had been found to be RH negative, and that was verified.

By Mar.4 a mass was palpable at the junction of the left Fallopian tube with uterus. Surgeon refused to operate at that time, and would have sent her home at the end of two weeks, but there was nobody there to take care of her. Very little uterine discharge occurred while she was in hospital. Antibiotics were given her. The surgeon discharged her Mar. 21, planning to operate a few months later.

She came back into my hands. There had been a trace of black flow Mar. 11. I gave her Psorinum 10M. Mass in left pelvis was very firm, and extended about two and a half inches outward from the fundus. She continued under my prescribing, reporting to the surgeon now and then. His examinations always confirmed my findings.

By Apr. 16 the mass was much smaller. Menses improved, but sometimes dark red and copious, briefly. By May 27 mass had reduced approximately half. She was working at her own housework. Sept. 17, mass was palpable as a small, indurated triangle in left pelvis. Had to get it between internal and external examining fingers to palpate it. Formerly, one could readily find it with internal fingers only.

By Jan. 19, 1953 I could find no trace of mass. May 9, the surgeon told her not to let anybody tell her she needed an operation.

Remedies that followed Psorinum 10M were Calcarea sulph., Scirrhinum, Graphites, Bellis per., Conium, Murex, Thuja, Cyclamen, Ustilago, Secale (once when menstruation became copious), Cancerinum, Condurango, and Sulphur. I still examine her occasionally, if there is any variation from normal in the menstrual function, as pain as dark flow. But no indication of a mass has recurred. Erigeron 10M was given under those circumstances (pain and some dark flow), Mar. 19, 1954. The April period was normal.

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