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The great stretching and tension upon this portion the wall when the perineum distended in labor, and the cicatricial traction caused ruptures at the posterior vaginal entrance during healing, complete the process.

Nevertheless, undeniable that in many cases exquisite prolapse this kind, there are no perineal cicatrices. The partial protrusions the upper segment the posterior wall occur only exceptionally as lax transverse folds cheap essay writing service usa the mucosa, at the place the normal posterior cul-de-sac the vaginal vault more generally they are seen as extensive inverted depressions the posterior varinal vault. These are really secondary occurrences dissertation assistance writing since they are dependent upon descent the uterus, or Douglas's pouch, or upon excessive dilatation the recto-vaginal septum from the side the rectum. In the latter case they are large from the beginning, and involve the entire extent the posterior wall above the perineum.

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When the rectum is full the sac tense and does not fall but when empty immediately The participation the anterior rectal wall in the protrusion, rectocele vag. occurs either a small extent only or not at all.

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Only where there a high degree total prolapse does occur any extent. The tumor may then, as Freund has shown, reach an extreme size. All the help writing essay partial dislocations the posterior wall are easily increased by the pressure exercised upon the tumors the uterus and intestines, and the abdominal pressure. They may then form extensive prolapses, their lower end usually appearing free just behind the posterior commissure the vulva. The retroflexed uterus always follows the tumor, when not fixed in the pelvis tumors or adhesions and the peritoneal excavatio retro-uterina always drawn deeply down.

Secondary protrusions are formed when the retro verted and enlarged uterine body, or tumors the uterus or its adnexa, or encapsulated collections fluid liEematocele, pel vio peri tonitic abscess, hydrops saccatus or an extra-uterine foetal sac, literature review writing services lie in and depress Douglas's cul-de-sac. Free fluid may also, though more rarely, the same thing, as when there is much ascites. We must agree with Hegar and write my paper please Kaltenbach in regarding hernia vag.

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post, or enterocele vag.

as a rare cause protuberance of the posterior wall without uterine doctoral dissertations online prolapse being present.

The reason is that the coils small intestine which lie in Douglas's cul-de-sac can be more easily displaced and forced into the abdominal cavity, than could the elasticity the walls the cul-de-sac overcome, and the vaginal surface cv writing service protruded.

There must at all events a relatively narrow entrance Douglas's cul-de-sac, which may course occur from an increased development the sickle-shaped connecting band the plica? semilun. which Kohlrausch has figured, help with comparative essay or from acquired pathological adhesions. In this case the tension the hernial tumor may great enough cause a considerable displacement the womb, and hinder umi dissertation services reposition. This had occasion see ourselves in the case shown in Figs. Landau relates an interesting case which belongs here. A woman forty-eight years old had had nine children, and suffered from ob Report Spiegelberg's Klinik at Breslau for, in Berl. Kl. The result was wonderful. 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