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Thus in Amussat's well-known case, a total vaginal occlusion in a girl fifteen years old was rendered patent simple digital pressure, and the continuous use sponge tents, that eventually the collum could incised and the retained menstrual blood evacuated.
Two years later the patient was perfectly well. In a similar way Gantvoort obtained write my research paper for me for free a permanently good result in a girl fourteen years old, in whom there was supposed to fin entire absence the vagina. Bidder also succeeded with his finger in opening the apparently absent vagina in a girl seventeen years old suffering from hoematometra, that puncture the collum could be done, and the patient relieved, although a vaginal stenosis remained behind. There no doubt that in these best dissertations cases there was no real defect or cicatricial stenosis, but rather a firm adhesion the vaginal walls one another. Veit has claimed that this was the fact in Amussat's case and this not much because the membrane covering the atresia offered little resistance as because the right passage the portio vag. was who can write my essay so quickly found and easily kept open. Since impossible before attempting dilatation, distinguish these adhesions from real obliterations, would well before proceeding operate make an attempt force If the atresia covered with a smooth mucous membrane, or if the attempt effect a passage with the finger has failed, we now proceed to split the mucous membrane with scissors or knife, bearing in mind the precautions recommended above. Then make our way with a blunt instrument phd thesis proposal through the deeper layers tissue towards the tumor, while an assistant with a metallic catheter controls the urethra and the bladder, and with his finger guards the rectum. The finger, aided occasionally a blunt closed pair scissors, the best instrument that can employ.
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If bands firm tissue are met with, they may divided with the latter instrument.
When thus reach the fluctuating wall the retention-tumor, must palpate carefully decide whether cannot distinguish the region the cervix as a soft, depressible round spot i need help in writing an essay in its walls. This often the case when ouly a small remnant the fornix division the vagina preserved above the atresia. It cannot dltk custom writing paper felt, course, when the lower portion the tumor formed a large section vagina, and tense. I have repeatedly succeeded in finding and have experienced its usefulness in facilitating future utero vaginal communication since only when the place properly selected that the cervix assumes its position in the lumen the vagina.
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I use a longhandled lancet-shaped knife, effect the opening, either at the site of the cervix, if cannot found, at the lowest part the vault of the tumor the blade being protected a large canula controlled a spring.
Drawn back into the canula, and thus guarded, the knife may safely passed under guidance the finger the selected Emmet's rule, make the division with the blunt instrument as large as possible, as obtain a wide passage, only followed with great caution.
Too extensive lateral movements the finger injure the pelvic connective tissue needlessly, and if the course the wound not a thoroughly aseptic one, favor the occurrence extensive phlegmona pelvica. Compare Table.
spot, and applied The blade then projected until enters the retention tumor and then the puncture enlarged right and left with the knife. The opening should about fth an inch broad. Then the blade withdrawn into the canula, the knife removed entirely, and the canula pushed deep into the tumor. I then use the instrument which I call forceps canula. It consists in principle a canula split into two halves, which a strong, double curved dilatation Forceps Canula closed in a and open in forceps has been added. This instrument passed over the canula, which exactly fits, and pushed closed into the retention sac.