A Textbook Of Gynecology Sixth EditionPDF电子书下载

SECTION Ⅰ．ANATOMY 1

CHAPTER 1 ANATOMY OF THE FEMALE PELVIS AND PERINEUM 3

Pelvis 3

Perineum 4

Anal Region (Anal Triangle) 4

Urogenital Region (Urogenital Triangle) 9

Pelvic Cavity 25

Peritoneum 25

Extraperitoneal Tissue 27

Pelvic Viscera 27

Urinary and Digestive Organs 27

Urinary Bladder，Urethra，and Ureters 27

Sigmoid Colon，Rectum，and Anal Canal 29

Genital Organs 31

Uterus 31

Vagina 34

Fallopian Tubes 36

Ovaries 39

Endopelvic Fascia and Ligamentous Supports 42

Vessels and Nerves of Pelvis and Perineum 54

Arteries 55

Veins 65

Lymphatic Vessels and Glands 65

Nerves 69

Muscles of Pelvis 77

CHAPTER 2 EMBRYOLOGY OF THE GENERATIVE ORGANS 80

SECTION Ⅱ．PHYSIOLOGY (Exclusive of the Endocrine Glands) 93

CHAPTER 3 FUNCTIONS OF THE GENITALIA 95

CHAPTER 4 THE PERIODS OF A WOMAN＇S LIFE 100

Infancy and Childhood 100

Adolescence 100

Sexual Maturity or the Reproductive Period 102

The Menopause (Climacteric；Change of Life) 102

Genital Senility 105

SECTION Ⅲ．THE ENDOCRINES 107

CHAPTER 5 THE ENDOCRINE GLANDS 109

The Pituitary Gland 109

The Follicle-Stimulating and Luteinizing Gonadotropic Hormones 112

The Lactogenic Hormone (Prolactin) 115

The Adrenotropic (Corticotropic) Hormone 115

The Growth and Thyrotropic Hormones 115

The Posterior Lobe of the Pituitary Gland 115

The Adrental Hormones 116

The Ovarian Hormones 116

Relaxin 119

The Androgenic (Male) Hormone 120

CHAPTER 6 MENSTRUATION (THE MENSTRUAL CYCLE) 122

Cyclic Changes in the Endometrium 122

The Mechanism of Menstruation 126

Clinical Characteristics of Menstruation 126

Hygiene at the Time of Menstruation 129

CHAPTER 7 CYCLIC CHANGES IN THE OVARIES AND OTHER GENITALIA 131

CHAPTER 8 CLINICAL ENDOCRINOLOGY 138

Hormonal Assays 139

Estrogens 139

Progestin 139

Androgens 140

Gonadotropic Hormones 140

Other Diagnostic Aids 141

Endometrial Biopsy and Curettage 141

Vaginal Smears 142

Basal Temperature Records 142

Principles of Endocrine Therapy 142

Estrogens 143

Progesterone 145

Androgens 145

Gonadotropins 147

Thyroid Substance 148

Vitamin and Nutritional Therapy in Endocrine Disturbances 148

Management of the Menopause 148

SECTION Ⅳ．HISTORY AND EXAMINATION 153

CHAPTER 9 THE GYNECOLOGICAL PATIENT PRESENTS HERSELF 155

The History 155

The Examination 158

SECTION Ⅴ．INFECTIOUS PROCESSES 165

CHAPTER 10 GONORRHEAL DISEASE OF THE FEMALE GENITALIA 167

Pathology and Diagnosis 167

1．Gonorrheal Disease of the External Genitalia and Cervix 167

Source and Onset of the Infection 169

2．Gonorrheal Disease above the level of the Cervix 176

Special Factors in Ascent of the Infection 176

Progress of the Disease 177

Diagnosis of Acute Gonorrheal Disease of the Tubes 185

Diagnosis of Chronic Gonorrheal Disease of the Tubes 186

Treatment of Gonorrheal Disease 188

Sulfonamide Therapy 189

Penicillin Therapy 189

Non-specific Management and Surgical Treatment 190

Treatment of Persistent Infection of the Lower Genital Tract and Lesions Resultant from Infection 191

Treatment of Gonorrheal Disease Above the Level of the Cervix 194

Treatment of Acute Adnexal and Peritoneal Infection 194

Treatment of Persistent Adnexal and Peritoneal Infection and Lesions Resultant from Infection (Residues of Infection) 196

CHAPTER 11 GONORRHEAL DISEASE IN FEMALE CHILDREN 202

CHAPTER 12 THE＂CELLULITIS GROUP＂OF PELVIC INFECTIONS 205

1．Postabortive Infection 205

Introduction 205

Etiologic Factors 206

Pathology 207

Diagnosis of Postabortive Infection 209

2．Puerperal Infection 211

Bacteriology of Puerperal Infection 212

Pathology of Puerperal Infection (from a Gynecological Viewpoint) 214

Diagnosis of Puerperal Infection 215

Diagnosis of Acute Puerperal Infection 215

Diagnosis of Chronic Puerperal Infection and Its Sequelae 216

3．Pelvic Cellutitis of Other Etiology 216

Treatment of the＂Cellulitis Group＂of Pelvic Infections (Postabortive Infection，Puerperal Infection，and Pelvic Cellulitis of Other Etiology) 218

Treatment of Acute Pelvic Cellulitis 219

Treatment of Chronic Pelvic Cellulitis，Its Sequelae and Complicating Associated Lesions 221

CHAPTER 13 GENITAL TUBERCULOSIS 225

Diagnosis 229

Treatment 230

CHAPTER 14 SYPHILIS 233

Syphilis of the External Genitalia 233

Syphilis of the Internal Genitalia 235

CHAPTER 15 ＂NONSPECIFIC＂INFECTIONS 239

1．Infections Resembling Gonorrhea 239

2．Ulcus Vulvae Acutum 240

CHAPTER 16 CHANCROIDAL INFECTION (SOFT CHANCRE) 241

CHAPTER 17 GRANULOMA INGUINALE 245

CHAPTER 18 LYMPHOGRANULOMA VENEREUM (LYMPHOPATHIA VENEREUM，LYMPHOGRANULOMA INGUINALE，SUBACUTE INGUINAL LYMPHOGRANULOMATOSIS，CLIMATIC BUBO) 249

SECTION Ⅵ．TUMORS OF THE UTERUS 255

CHAPTER 19 UTERINE MYOMAS (FIBROIDS) 257

Etiology 257

Pathology 257

Diagnosis 269

Differential Diagnosis 274

Treatment 277

CHAPTER 20 CARCINOMA OF THE CERVIX 294

Etiology 294

Pathology 296

Cancer of the External Cervix 296

Cancer of the Endocervix 299

Histology 299

Diagnosis 303

Differential Diagnosis 313

Treatment 315

Introduction 315

Nonoperative Management 316

Surgical Adjuncts to Radiation Therapy 321

Operative Treatment 322

Ureteral Transplantation 327

Relief of Suffering－Management of Hopeless Cases 327

Prognosis 329

CHAPTER 21 CARCINOMA OF THE BODY OF THE UTERUS 332

Etiology 332

Pathology 334

Diagnosis 339

Differential Diagnosis 341

Treatment 342

CHAPTER 22 OTHER TUMORS OF THE UTERUS AND HYPERTROPHY OF THE UTERUS 346

Polyps of the Cervix and Endometrium 346

Placental Rests and Polyps 350

Hydatiform Mole 351

Chorio-epithelioma 355

Sarcoma of the Uterus 361

Cysts of the Uterus 372

Hypertrophy of the Uterus 373

Diagnosis 376

Treatment 377

SECTION Ⅶ 379

CHAPTER 23 TUMORS OF THE OVARY 381

Classification 382

Ovarian Cysts 382

Inflammatory Cysts in or Near the Ovary 382

Small Multiple Cysts 385

Follicular Cysts 385

Inclusion Cysts 387

Corpus Luteum Cysts 387

Theca Lutein Cysts 387

Ovarian Cystomas 388

Papillary Fibromas (Surface Fibromas) and Warty Ovaries 388

Fibroadenoma and Cystadenofibroma 389

Mesonephric Cysts and Tumors 389

Endometrioma 392

Cystadenomas 393

Malignant Degeneration of Cystadenomas 397

Brenner Tumors (Oophoroma) 407

Dermoid Cysts and Teratoma 411

Carcinoma of the Ovary 418

Primary 420

Secondary 423

Connective Tissue Tumors 427

Fibroma 427

Sarcoma 429

Parovarian Cysts (Broad Ligament Cysts) 429

Dysgerminoma (Seminoma) 431

Granulosa Cell Tumor 433

Theca Cell Tumor (Thecoma) 440

Arrhenoblastoma 444

Luteinoma or So-Called Adrenal-Like Tumor of the Ovary 448

CHAPTER 24 TUMORS OF FALLOPIAN TUBES，LIGAMENTS AND PELVIC CELLULAR TISSUES 458

Tumors of the Fallopian Tubes 458

Benign Epithelial Growths 458

Primary Carcinoma 460

Secondary Carcinoma 461

Tumors of the Ligaments and Pelvic Cellular Tissues 462

Tumors of the Round Ligaments 462

Tumors of the Uterosacral Ligaments 462

Tumors of the Broad Ligaments and Pelvic Cellular Tissues 463

SECTION Ⅷ．DISPLACEMENTS AND RELAXATIONS 467

CHAPTER 25 PATHOGENESIS OF CHILDBIRTH INJURIES (DIAGNOSIS AND SURGICAL INDICATIONS) 469

CHAPTER 26 RETRODISPLACEMENTS OF THE UTERUS 475

Pathology 476

Diagnosis 478

Differential Diagnosis 479

Treatment 480

Indications for Operation 483

Intra-abdominal Operations 487

Other Operations 489

CHAPTER 27 URETHROCELE，CYSTOCELE AND UTERINE PROLAPSE 491

Diagnosis 495

Treatment 497

Nonsurgical Measures 497

Choice of Operative Procedure 500

Notes on Operative Technic 502

After-treatment 504

CHAPTER 28 PERINEAL LACERATIONS AND RECTOCELE 518

Repair of Complete Laceration of the Perineum 521

Repair of Simple Lacerations (Perineorrhaphy) 524

Repair of Laceration with Rectocele 525

SECTION Ⅸ．DISTURBANCES OF FUNCTION 533

CHAPTER 29 DYSMENORRHEA 535

Etiology and Pathology 535

Secondary or Acquired Dysmenorrhea 535

Primary or Essential Dysmenorrhea 537

Management of Secondary Dysmenorrhea 538

Diagnosis and Treatment of Primary Dysmenorrhea 538

CHAPTER 30 UTERINE HEMORRHAGE 544

Etiology and Pathology 546

Constitutional and Systemic Causes 546

Complications of Pregnancy 546

Benign Tumors of the Uterus 547

Malignant Tumors of the Uterus 549

Other Diseases of the Uterus 550

Tumors and Inflammations of the Ovaries 551

Endocrinopathic or Functional Bleeding 551

Diagnosis and Treatment 553

Bleeding Ascribable to Demonstrable Pathology 553

Endocrinopathic and Functional Bleeding 554

CHAPTER 31 AMENORRHEA 558

Endocrinopathic Amenorrhea 559

Dystrophia Adioposogenitalis (Frohlich＇s Syndrome) 559

Simmonds＇ Disease 559

Cushing＇s Syndrome 559

Adrenogenital Syndrome 560

Primary Ovarian Deficiency 560

Diagnosis of Amenorrhea 560

Treatment 560

CHAPTER 32 STERILITY 562

Etiology and Pathology 562

Physiological Factors in Sterility 562

The Body of the Uterus in Relation to Sterility 563

The Cervix in Relation to Sterility 564

The Fallopian Tubes in Relation to Sterility 565

The Ovaries in Relation to Sterility 566

The Endocrines in the Etiology of Sterility 566

Diagnosis 567

Treatment 572

Physiologic Considerations 572

Routine Management 573

Endocrine therapy 574

Operative Intervention 574

SECTION Ⅹ 579

CHAPTER 33 ENDOMETRIOSIS 581

Etiology 581

Pathology 586

Diagnosis 594

Treatment 595

Surgical Indications 595

CHAPTER 34 ECTOPIC PREGNANCY 599

Etiology 599

Pathology 601

Diagnosis 609

Treatment 613

CHAPTER 35 LEUKORRHEA 616

Etiology 616

Pathology 619

The Cervix 619

The Vulvovaginal Tissues 620

The Uterus 622

Treatment 622

Routine Care 623

Trichomonas Vaginalis Vaginitis 624

Senile Vaginitis 624

Mycotic (Fungus or Yeast) Infections 624

Skene＇s Duct Infection 625

The Diseased Cervix 625

Intractable Cases 627

CHAPTER 36 GENITAL FISTULAS 629

Vesical Fistulas (Vesicovaginal，Vesicocervicovaginal，and Urethrovaginal Fistulas) 630

Ureteral Fistulas 636

Rectovaginal Fistulas 637

CHAPTER 37 BACKACHE 641

Backache from Nongynecological Conditions 641

＂Gynecological＂Backache 641

Recognition of the Lesion which Causes Backache 642

CHAPTER 38 DISTURBANCES OF THE PELVIC VEINS 644

Thrombophlebitis of the Deep Pelvic Veins 644

Femoral Thrombophlebitis (Milk-leg，Phlegmasia Alba Dolens) 644

Venous Thrombosis 645

Treatment of Pelvic and Femoral Thrombophlebitis and venous Thrombosis 645

Broad Ligament Varicocele and Passive Congestion of the Pelvic Veins 648

CHAPTER 39 ENDOMETRITIS 650

Acute Endometritis 650

Etiology 650

Pathology and Diagnosis 650

Treatment 651

Chronic Endometritis 651

SECTION Ⅺ 653

CHAPTER 40 LESIONS OF THE CERVIX 655

Cervical Erosions 655

Leukoplakia of the Cervix 657

Lacerations of the Cervix 657

Cervicitis 660

Papilloma of the Cervix 663

Cervical Stricture．Obstructions of the Uterus and Their Complications 664

Mesonephric Remnants in the Cervix 667

CHAPTER 41 PRURITUS VULVAE 672

CHAPTER 42 LEUKOPLAKIA VULVAE AND KRAUROSIS VULVAE 676

CHAPTER 43 CARCINOMA OF THE VULVA 680

CHAPTER 44 OTHER TUMORS OF THE VULVA AND VAGINA 685

CHAPTER 45 ELEPHANTIASIS 693

CHAPTER 46 VAGINISMUS AND DYSPAREUNIA 694

CHAPTER 47 ATRESIA OF THE GENITAL CANAL 698

CHAPTER 48 INVERSION OF THE UTERUS 700

CHAPTER 49 CONGENITAL MALFORMATIONS 705

Hymen and Vagina 705

Imperforate Hymen 706

Congenital Absence of Vagina 708

Uterus 710

Fallopian Tubes and Ovaries 713

Hermaphrodism 714

SECTION Ⅻ 717

CHAPTER 50 THE EARLY MONTHS OF PREGNANCY (FROM A GYNECOLOGICAL ASPECT) 719

The Early Diagnosis of Pregnancy 719

Complications of Early Pregnancy and Their Management 722

Toxemias of Pregnancy 723

Threatened Abortion 723

Habitual Abortion 725

Inevitable or Incomplete Abortion 725

Missed Abortion 725

Technic of Therapeutic Abortion；Technic of Curettage 725

CHAPTER 51 THE APPENDIX AND LARGE INTESTINE IN RELATION TO GYNECOLOGY 728

The Appendix 728

Pelvic Adhesions 728

Diverticulitis 728

Perforation of the Large Intestine 730

Mucous Colitis 730

Carcinoma 730

Nonmalignant Conditions of the Rectum and Anus 731

CHAPTER 52 URINARY TRACT PROBLEMS IN GYNECOLOGY 732

The Urethra 732

Urethral Caruncle 732

Other Benign Tumors of the Urethra 734

Prolapse of the Urethral Mucosa 735

Diverticula and Abscess Pockets 736

Urethral Stricture 737

Carcinoma of the Female Urethra 737

Vesical and Urethral Distress 737

Trigonitis and Urethritis 737

Pressure Upon the Bladder 739

Incontinence Without Demonstrable Pathology 739

Cystocele and Urethrocele 739

Residual Urine 740

The Ureters 742

CHAPTER 53 RADIOTHERAPY 744

Radium 744

Radium in the Treatment of Uterine Hemorrhage 744

Radium in the Treatment of Uterine Myomas 747

Radium in the Treatment of Carcinoma of the Uterus 747

Roentgen Rays 748

CHAPTER 54 OPERATIVE MANAGEMENT AND POSTOPERATIVE CARE 750

Preparation of the Patient 750

Anesthesia 752

Avoidance of Introducing Infection 753

Prophylaxis of Backache 754

The Abdominal Incision and Exposure 754

Operative Technic 755

Postoperative Care 758

Routine Measures 758

Paralytic Ileus and Intestinal Obstruction 762

Pulmonary Complications 763

INDEX 767