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A Note On Lithopaedion: With Report Of A Case Author(s): Paul Cave Source: The British Medical Journal, Vol. 1, No. 3972 (Feb. 20, 1937), pp. 383-384 Published by: BMJ Publishing Group Stable URL: http://www.jstor.org/stable/25355788 . Accessed: 31/08/2011 10:43
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Feb.
forward which cases on

20, 1937
healing was there the result of was some has the

TREATMENT
obtained in a

OF MINOR
number initial as of

BURNS
cases in

BY AMYL
and properties, ment of minor

SALICYLATE
can burns. be satisfactorily

^*
employed

AL 383
in the treat

of degree been classified that some

account

fact

during

result the treatment than because cases was in two of these five satisfactory. Only measures for sary to substitute stronger antiseptic two during of the treatment. the course Further, of more or less and on marked in the a in was present degree was another the burn (No. 40).

sepsis eventual

In five sepsis. " fair," more only was encountered was a day it will not or be it neces

on tannic acid the 2. It lacks the coagulant of effect and is therefore to the treatment unsuited of severe tissues, and extensive burns where is a danger of there toxaemia and shock.

3. The

ester has

little if any bactericidal

power,

and it
In this by

noted from Table A

sepsis they and an first attended, one extensive

that in three of these patients

a

initial
when deep other

therefore the addition of an requires a mixture series of isomeric substituted " name the trade has abracide," proved

antiseptic. phenols, suitable.

known

4. The method
as

is applicable

to tfie treatment of infected

scalds, provided the

forearm

One

case (No. 7) calls for special mention.

and sustained epileptic, small but situated size, burn the of leg. Healing to attend had for sixty-five third-degree the avascular was days. Cases accordingly

This
burn scar

patient
of

was

as non-infected well initial is not infection

burns and too seVere.

relatively an old of and he

5. Standardization
best results are to be 6. Amyl salicylate been

of technique
obtained. has an

is very necessary
penetrating

if the
smell,

slow,

but
esters

the results obtained

have inferior.

extremely

with

other

less pungent

salicyl

Illustrative

was Case I (No. 24).?The patient was seen on April 8, 1936, two hours to the right showed Examination leg. above the inch second-degree lesion as above. Healing Primary dressings no exudation with through factorily,

a female aged after a scalding a four-inch right

38. She accident by three

internal malleolus. satis very progressed the surface gauze layers. in the surface 27 shows taken on April A photograph gauze the gauze taken on May and a second one, "5, after position, a perfectly skin healed shows had separated spontaneously, No area with in its centre Plate). (see Special slight scaling pain throughout. a male was 38. He Case II (No. aged 16).?The patient and whole the face, of burns sustained neck, second-degree a from caused the left forearm, of by a blow-back length on March The accident occurred furnace. 1936, and he 23, was raised one hour The attended later. epithelium hospital with saline. cleansed surfaces and the removed Amyl were The and abracide gauze dressings applied. salicylate were the raw surfaces left intact, contact with in actual layers at threeand four-day the top layers were and only changed on was 30 the lesions intervals. By March Progress rapid. and by April 7 the forearm face and neck were healed, Comment: healed. No likewise throughout. fully pain surface burn clean A recent, ; primary dressing second-degree in situ. remained the was on the right scalded 16 was III (No. 39).?A Case girl aged at A thick foot on June 4, 1936. layer of flour was applied on June 5. Examination she attended and home, hospital infected an showed second-degree moist, extensive, mildly of the foot and the front of the ankle. the dorsum lesion over so that some the whole there was In this case exudation, to be changed three days later. had thickness of the dressings a minor the of exudation, there was degree Thereafter, though was intact and healing left surface gauze progressed deep some was 29. There complete by June being satisfactorily, the first five days of treatment. Comment: discomfort during hours' infected A mildly which, duration, injury of twenty-four however, progressed satisfactorily. on May woman IV (No. 34).?A Case 28, aged 40 attended on the lesion a five-days-old second-to-third-degree 1936, with was a brown in the There caused foot slough by a scald. and skin was swollen. the surrounding centre and congested and After Considerable salicylate cleansing amyl gentle pain. were to the nature of the abracide Owing dressings applied. of and the exudation case considerable there was sero-pus, at four-day had to be changed of the dressings thickness whole was and the 15 the condition June intervals. painless By was June 29. clean. surface very by Healing complete Comment by amyl infected quite markedly and abracide. salicylate :A Summary 1. Clinical indicated have tests that in hospital out-patient possesses amyl salicylate a department analgesic burn treated throughout

to Dr. T. H. Durrans, and director of research indebted for to Messrs. and Co. Ltd., Roberts A. Boake, am 1 also the assistance throughout inquiry. to Sister Dewar of the surgical out-patient grateful sincerely her the Edinburgh of ; without Infirmary Royal department constant of the work of her staff the investigation supervision would have been impossible. development and advice

I am

A NOTE ON LITHOPAEDION
WITH REPORT OF A CASE BY CAVE, M.B.,
Royal Special (With

PAUL
Honorary

D.M.R.E.
Berkshire Plate) Hospital

Radiologist,

Of
cites

all pathological
the most being the and reported. number

conditions
and In of spite cases

Iithopaedion
for of in since this this the then reason

probably
few is

ex
cases rela

curiosity,

escape publicity cases,

tendency literature is

to over

tively few.

For
the

instance, up to 1933 the total was

number added insignificant.

196

illustration of its rarity is derived from the figures Another of the Mayo Clinic for the years 1903 to 1926. During this period nine lithopaedions were found in 445 cases
of extra-uterine pregnancy. The incidence of 2 per cent,

is probably the highest that will ever be recorded, as with of a retained foetus Iithopaedion increased recognition
formation cases of rare. still more become one considers when surprising be present which must circumstances will is not can be formed. must cases very be of extra-uterine. intra-uterine literature, extreme It is true The the paucity combination a of

before

Iitho

paedion

the pregnancy First, a dozen half that about are to reported view their in the

early with in

lithopaedions none but since

have appeared within

authenticity

the last hundred years a case of

bicornuate twins uterus

it is rational
Nor

scepticism.

is it possible
record case twenty tion, but

to discover

Iithopaedion
uteri. were was there Even retained

in the
in a for

of pregnancies almost in which years no calcification. the If death will advanced on its cavity. is said be foetus occurs

full-term

in a bicornuate

skeletoniza

Secondly, months. absorption nancy ruptures peritoneal plantation

must while and

survive the

for bones

rapid

development side the free But to

complete. is rare, embryo

than three longer are cartilaginous In tubal preg and if dies the in tube the im

usually

secondary favour survival.

intraligamentous

384

Feb.

20,
the

1937
must by escape

A NOTE
medical notice, the mother to occur. from the

ON LITHOPAEDION
else must The con An

m.^jSSXal
Present Case

Thirdly, it will be survive shortest ception, is made. Fourthly, certainly symptoms Fifthly, calcium ditions factor in are

condition

terminated

long enough recorded period but usually the produce the the is is no to friable this foetus it

; also operation for calcification is is many fourteen years remain and before

months

discovery will lead to

must

sterile. moreover

Infection will

absorption, operation.

necessitating

necessary tissues must not to be

conditions be present.

for

deposition What these an

of con

appears connexion it Iithopaedion exception necrotic

understood, fully a sluggish local that placenta in

but almost could

circulation.

important In this

significant trace of

case of every be found. An a In of large his cal

case, however, careous matter portions It would in foetuses of the seem

is recorded found who by Clark, to the pelvis. attached placenta were a few there only patches the sparingly interspersed through tissues and in that the the enveloping absence of

obese in the left of pain 83. complained woman, aged for She was to me referred .v-ray hip as the result of a fall. a crushed The examination. of showed fracture radiograph the greater and also dense in the pelvis. shadows trochanter, were Some of these I shadows bones. of foetal obviously exam endeavoured to get the patient to return for a thorough ination of the pelvis, not consent. but she would A few days later she died of cerebral Her relative, haemorrhage. only a niece about for a post-mortem 50, refused aged permission to an x-ray but agreed of the body. examination investigation, me She a particularly informed aunt that her had been woman ever atten who had hardly medical healthy required was tion. one There child born about previously. fifty years The niece remembered that some the birth of this time after child her aunt How that she was thought pregnant. again labour was did not come on and the incident ever, forgotten. The date of this pregnancy is not known, but it is likely to be more than forty-five years ago. On palpation of the abdomen, when the body was brought a large, hard, for x-ray I found smooth examination, swelling a foetal head above the antero The resembling pubis. a calcified view shows full-term foetus its posterior lying on left side in the pelvis. The is to the right and the head to the left of the midline. arms and legs are flexed. back The The lateral view shows the breech in the hollow of the lying sacrum. The are head and thorax above the pelvic brim. The on the chest. head is acutely flexed view makes This it obvious that the hard mass the pubis was the back felt above of the neck and the head. shoulders and not There is very of the cranial it is not sufficient but slight overlapping bones, to decrease the size of the foetal skull. The thoracic materially are almost and lumbar spines straight. Calcification is chiefly in the membranes, which be about the thickness of a foetal rib. Calcification seen in the tissues, in the arms. Thus especially be classified under the known may paedion type kelyphopaedion. I am to Dr. indebted of Newbury for Leggatt to publish the case, and to Mr. A. O. Forder, Royal for the radiographie Hospital, Reading, prints. Bibliography P. B., Goldstein, and Bolton, W. W. Bland, L., (1933). Surg. 939. Obstet., 56, Gynec. P. F. (1929). Amer. J. Roentgen., 365. Butler, 21, J. G. Johns Hopk. Clark, (1897). Hosp. Bull., 8, 221. E. L. (1922). Amer. J. Obstet. Gynec, R., and King, D'Auhoy, 3, 377. F. (1932). 646. Emmert, Obstet., 55, Surg. Gynec. A. Trans, med. Soc. Land., 137. Goodwin, (1931). 54, H. W. Grimm, Radio!., 17, 576. (1931). C. G., and Wills, S. H. (1934). Amer. J. Obstet. Johnson, Gynec, 282. 28, J. C, and Simon, H. E. Masson, (3928). Surg. Gynec. Obstet., 500. 46, L. S. (1932). J. Obstet. 894. Amer. Otell, 23, Gynec, F. (1932). Amer. J. Roentgen., Sant?, L. R., and Emmert, 127, 262. J. (1916). and Forman, Amer. J. Obstet., 470. Scott, Ernest, 73, permission Berkshire to appear is also the litho as litho

external

membrane. calcification the the

retained

probable in a

bicornuate

is explicable years, lapse of many is too good circulation for these

even after uterus, on the grounds that to occur. changes

Classification

of Lithopaedions

and Diagnosis

The sites in which calcium is laid down have formed the basis of a classification of lithopaedions into three
types. and 1. Lithokelyphos.?The not adherent mummified, to be due of membranes to to the or foetus. The skeletonized. alone foetus This remaining and This fluid. foetus alone is are may type calcified be is un

changed,

posed the termination are

the membranes

sup at intact

pregnancy. membranes to one another. of amniotic foetus type

2. Lithokelyphopaedion.?The are adherent and calcified the escape or (true deposition absorption

follows

3. Lithotecnon calcified, caseosa. cavity, the The leaving

Iithopaedion).?The of lime salts foetus behind,

of the escape its membranes

in the vernix starting the abdominal into is said to account

for this type. Lithokelyphopaedion

the three. discovery course of of The in the

is probably

the most

common
accidental? radiographie

of

a Iithopaedion is often or clinical examination

or at post-mortem. The investigation, patient unaware of her The condition. usual history " " mock labour followed decrease by gradual of the abdomen and the return of menstruation. gressive "Sant? hard shrinking and mass Emmert. of a full-term On foetus of pubis. attaches pain or

be may a is of in the size Pro mass

to a calcified

the size of a fist has been observed

be felt may knows of its existence, patient to it on account the absence of In may pelvis, 60 be per mild cystitis, from of cent, of cases palpation above the but of

radiographically
the abdomen

by
a

Sometimes the no importance discomfort. occur. fullness and viscera There in adhesions are by radio limbs dis is and the often of rule. an the the con

late pain,

abdominal vaginal

symptoms sense of and into

discharge,

sciatica

stipation and rupture the commoner graphy dermoid There acute

pressure. intrapelvic the Iithopaedion serious

Abdominal adjacent Diagnosis of foetal foetus bones Distribution

is usually cysts.

complications. The presence simple. of the

J. D?rffel and W. (Derm. Wschr., Lutterberg 2, January causes the different of sterility in men. 1) review 1937, p. Collected statistics show that bilateral gonorrhoeic epididy is responsible for 50 to 100 per cent, mitis of azoospermia. The are authors think that those statistics useful only are on which based the examination of the ejaculated semen in all cases of bilateral and not epididymitis, only come as a result for examination in cases which of alleged The authors' have shown sterility. personal investigations to occur in about cent, cases 50 per of all of sterility

tinguishes

the shadows

from those of calcified fibroids or

bilateral
only very

epididymitis.
rarely.

Recanalization
was

of the duct occurs

found There also seems smoking to in a

Compression is overlapping of the cranial or dorsal cervical kyphosis.

number

of cases of unilateral
disturbances. between

Azoospermia

epididymitis
excessive

and also

in
be and

calcified

areas varies with

the type of

Iithopaedion.

constitutional certain a too, relationship, azoospermia.

FEBRUARY 20, 1937 N. HAMILTON FAIRLEY AND F. P. MACKIE : THE CLINICALAND BIOCHEMICAL SYNDROME IN LYMPH ADENOMA AND ALLIED DISEASES

The British Journal Medical

PAUL CAVE : CASE OF LITHOPAEDION

?3r

Lymphoma of the mesenteric stasis and a sprue-like syndrome.

lymph glands (Case I.)

associated

with

lympli

Antero-posterior

view.

R. LESLIE STEWART : TREATMENT OF MINOR BURNS BY AMYL SALICYLATE AND OTHER SALICYL ESTERS
'S-^v^ #

;'>^-?C"

/^

Fio. 1 .?Case I (No. 24). Scald on leg. Primary surface dressing still adherent nineteen days after commencement of treatment.

Fio. 2.?Case I (No. 24). Eight days later. The primary gauze layer has been shed. The injury is perfectly healed with slight surface scaling seen in the centre.