Communications in brief
\"olunw I~ :~ :\ nm ht"r X
919
Fig. 1. Photograph o f the spinal cord showing a hematoma in the r egion of fourth and fifth cervical vertebrae (arrow) .
cord at the level of the fourth and fifth ce rvical vertebrae and recent subdu ral hemorrh age (Fig. I ).
It is obvious that traction on the infant is always . dangerous. whatever the presentation. Indeed , the occ urrence of spinal lesions has decreased tremendously si nce cesarean section has become the method of choice in a difficult delivery. Cesarean section has bee n promoted as the best way to deliver infants in breech prese ntation with a h yperextended head when the diagnosis has been made radiologically. However, this procedure does not consistently protect the baby: one case of vertebral trauma has been reponed. In addition, one case of cervicothoracic transection has been re ported among nine cases of cesarean section for transverse lie with hyperexte nded head (opisthotonus fetalis or Hying fet us). Although th e birth process and , more specifically. the sudde n flex ion of the head as the fetus desce nds into the vagina, must probably be incriminated most of the time, there is evidence that occasionall y the lesion occurs before labor begins. H ence , there is the possibility o f spinal lesion after cesa rea n section . The prese nt case supports this hypothesis. Th e classica l progression of lower limb paralysis is first complete paral ysis with no reflex activity. After a few days to a wee k, reflex activity begins to appear. T he fact that thi s baby had refl ex activit y at birth suggests that the lesion was not a recent one a nd that the baby had alread y recovered from the initial state of shock. REFERENCES 1. Abroms, J. F. , Bresnan, M.J., Zuckerma n,J. E., fischer. E.
G., a nd Strand, R. : Obstet. Gynecol. 41: 369, 1973. 2. H ellstrom, B. , and Sall mander, U.: J. A.M . A. 204: 1041. 1968 . 3. Crothers, B.: Am. J. Med. Sci. 165: 94, 1923.
Granulomatous oophoritis due to Schistosoma mansoni KHALID MAHMOOD. M.R.C.PATH.(l.o:-.o .)
Department of Pathology, Presbyterimt-Unil'm;it\' Ho> jJital. PitL1bu·rgh. Pennsylvania
is the most co mmon and most important of the diseases ca used by flukes. The gynecologic lesions caused by Schistosoma ntansoni have been described in the past but their incidence is low.
ScHISTOSOMIASIS
A 29-year-old black West Indian lad y, the mother of three children . was admitted to the Royal Gwent Hospital. Newport. So uth Wales. England , on June 20, 1973 . H er solitary co mplaint was periodic bleeding from an a bdominal scar. Three ye ars prior to this hos pitali zat ion, she had tuba l ligation and hysterotomy. Ph ysical exa min atio n was normal. There was no abnormal finding in th e peripheral blood film. and a chest x-ray was norma l. T he preoperative diagnosis of e ndometriosis o f the abdomin al scar was made. and laparotomy was carried out. Bot h ovaries showed small cysts o n the surface. At operation, the abdo min al sca r tissue with both ovaries was removed. The right ovarian tissue measured 3.2 by 2.0 bv 0.8 em. T he cut surface showed small cysts and tin y hemorrhagic areas with a small area of yellowish mottling. The le ft ovarian tissue meas ured 4.0 by 2.0 by 1.2 em. The cut surface was similar to that of the rig ht ova r y. The abd omina l scar tissue measured 9.5 by 3.5 by 3.0 em . Section s throu gh the tissues of both ovaries showed evidence of endometriosis. There was ev idence of extensive gran ulomatous inflamm atio n with pseudotubercle formation around Schistosoma mansolti eggs (Fig. I ). The section s through th e abdominal scar tissue showed evidence of endometriosis.
Reprint requests: Dr. Kh alid Mahmood , Department of Pathology. Presbyterian- Unive rsit y H ospital. 230 Lothrop St., Pittsburgh. Pennsylvania 152 13 .
920
Communications in brief
lkTcnlht'r I;-,, I ~J(.:-, Ohsl('t. ( ;, lll'
\"olunw I~ :~ :\ nm ht"r X
919
Fig. 1. Photograph o f the spinal cord showing a hematoma in the r egion of fourth and fifth cervical vertebrae (arrow) .
cord at the level of the fourth and fifth ce rvical vertebrae and recent subdu ral hemorrh age (Fig. I ).
It is obvious that traction on the infant is always . dangerous. whatever the presentation. Indeed , the occ urrence of spinal lesions has decreased tremendously si nce cesarean section has become the method of choice in a difficult delivery. Cesarean section has bee n promoted as the best way to deliver infants in breech prese ntation with a h yperextended head when the diagnosis has been made radiologically. However, this procedure does not consistently protect the baby: one case of vertebral trauma has been reponed. In addition, one case of cervicothoracic transection has been re ported among nine cases of cesarean section for transverse lie with hyperexte nded head (opisthotonus fetalis or Hying fet us). Although th e birth process and , more specifically. the sudde n flex ion of the head as the fetus desce nds into the vagina, must probably be incriminated most of the time, there is evidence that occasionall y the lesion occurs before labor begins. H ence , there is the possibility o f spinal lesion after cesa rea n section . The prese nt case supports this hypothesis. Th e classica l progression of lower limb paralysis is first complete paral ysis with no reflex activity. After a few days to a wee k, reflex activity begins to appear. T he fact that thi s baby had refl ex activit y at birth suggests that the lesion was not a recent one a nd that the baby had alread y recovered from the initial state of shock. REFERENCES 1. Abroms, J. F. , Bresnan, M.J., Zuckerma n,J. E., fischer. E.
G., a nd Strand, R. : Obstet. Gynecol. 41: 369, 1973. 2. H ellstrom, B. , and Sall mander, U.: J. A.M . A. 204: 1041. 1968 . 3. Crothers, B.: Am. J. Med. Sci. 165: 94, 1923.
Granulomatous oophoritis due to Schistosoma mansoni KHALID MAHMOOD. M.R.C.PATH.(l.o:-.o .)
Department of Pathology, Presbyterimt-Unil'm;it\' Ho> jJital. PitL1bu·rgh. Pennsylvania
is the most co mmon and most important of the diseases ca used by flukes. The gynecologic lesions caused by Schistosoma ntansoni have been described in the past but their incidence is low.
ScHISTOSOMIASIS
A 29-year-old black West Indian lad y, the mother of three children . was admitted to the Royal Gwent Hospital. Newport. So uth Wales. England , on June 20, 1973 . H er solitary co mplaint was periodic bleeding from an a bdominal scar. Three ye ars prior to this hos pitali zat ion, she had tuba l ligation and hysterotomy. Ph ysical exa min atio n was normal. There was no abnormal finding in th e peripheral blood film. and a chest x-ray was norma l. T he preoperative diagnosis of e ndometriosis o f the abdomin al scar was made. and laparotomy was carried out. Bot h ovaries showed small cysts o n the surface. At operation, the abdo min al sca r tissue with both ovaries was removed. The right ovarian tissue measured 3.2 by 2.0 bv 0.8 em. T he cut surface showed small cysts and tin y hemorrhagic areas with a small area of yellowish mottling. The le ft ovarian tissue meas ured 4.0 by 2.0 by 1.2 em. The cut surface was similar to that of the rig ht ova r y. The abd omina l scar tissue measured 9.5 by 3.5 by 3.0 em . Section s throu gh the tissues of both ovaries showed evidence of endometriosis. There was ev idence of extensive gran ulomatous inflamm atio n with pseudotubercle formation around Schistosoma mansolti eggs (Fig. I ). The section s through th e abdominal scar tissue showed evidence of endometriosis.
Reprint requests: Dr. Kh alid Mahmood , Department of Pathology. Presbyterian- Unive rsit y H ospital. 230 Lothrop St., Pittsburgh. Pennsylvania 152 13 .
920
Communications in brief
lkTcnlht'r I;-,, I ~J(.:-, Ohsl('t. ( ;, lll'
